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Predominant nocturnal acid reflux in patients with Los Angeles grade C and D reflux esophagitis
Author(s) -
Adachi Kyoichi,
Fujishiro Hirofumi,
Katsube Tomoko,
Yuki Mika,
Ono Masahiro,
Kawamura Akira,
Rumi Mohammad Azharul Karim,
Watanabe Makoto,
Kinoshita Yoshikazu
Publication year - 2001
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1046/j.1440-1746.2001.02617.x
Subject(s) - reflux esophagitis , reflux , gastroenterology , medicine , esophagitis , nocturnal , gerd , gastric acid , esophagus , esophageal disease , esomeprazole , proton pump inhibitor , esophageal ph monitoring , disease , stomach
Background and Aims: Nocturnal gastric acid breakthrough (NAB) is defined as an intragastric pH < 4.0 lasting more than 1 h during the night in patients taking a proton pump inhibitor (PPI). Gastroesophageal reflux disease (GERD) patients with nocturnal gastroesophageal acid reflux accompanied by NAB are thought to be refractory to PPI treatment. The aim of this study was to endoscopically identify the patients with predominant nocturnal gastroesophageal acid reflux. Methods: The subjects were 37 patients with erosive reflux esophagitis (Los Angeles classification (LA) grade A, 12; B, 10; C, eight; and D, seven cases) and a control group of 20 patients without esophagitis. The results of ambulatory 24 h gastric and esophageal pH monitoring were compared among different grades of esophagitis. Results: Gastroesophageal reflux during 24 h in patients with high‐grade esophagitis was more frequent than for patients with low‐grade esophagitis or no esophagitis. Although the length of esophageal acid exposure (percentage time with pH < 4.0) in patients with grade A or without esophagitis was longer in the daytime, that in patients with grades C and D was longer during the night. The reason for the delayed nocturnal acid exposure was the longer nocturnal acid clearance in high‐grade reflux esophagitis. Conclusions: Nocturnal exposure of the esophagus to acid occurs frequently in patients with LA grades C and D esophagitis. Thus, the existence of NAB with resulting nocturnal acid reflux should be considered when the patient with high‐grade esophagitis shows resistance to PPI treatment.