Review article: is stringent control of gastric pH useful and practical in GERD?


:As the relative efficacy of therapeutic agents in the treatment of gastro-oesophageal reflux disease is related to how consistently and completely gastric acid secretion is suppressed, intragastric pH monitoring is a useful tool in stratifying therapies. If there is no acid in the stomach, there can be none to reflux into the oesophagus. Comparative crossover studies have shown consistently that once-daily esomeprazole (40 mg) provides more effective and longer lasting intragastric acid control than any other proton pump inhibitor currently available in healthy subjects and patients with gastro-oesophageal reflux disease. However, esomeprazole maintained intragastric pH > 4 for > or = 16 h in only about 55% of individuals tested. Thus, if more complete acid suppression is desirable, twice-daily proton pump inhibitor therapy may be advantageous. One such scenario is in patients with Barrett's metaplasia. Data from the ProGERD study suggest that, for each Los Angeles grade of oesophagitis, the healing rate for patients with Barrett's metaplasia is 10-30% less than that for non-Barrett's patients, being as low as 53% in patients with Los Angeles grade D oesophagitis. Also relevant to the Barrett's metaplasia population are studies on the oesophageal mucosa, which show that effective acid suppression favours differentiation and decreases epithelial cell proliferation. Both considerations argue for more intensive gastric acid inhibition than can be achieved with once-daily therapy, leading to experimentation with twice-daily proton pump inhibitor regimens. A randomized, double-blind, three-way crossover study compared esomeprazole 40 mg once daily with esomeprazole 20 mg and 40 mg twice daily and found that both twice-daily regimens were superior, maintaining intragastric pH > 4 for 73%[95% confidence interval (CI), 67-79%] and 80% (95% CI, 75-86%) of the day, respectively, compared with 59% (95% CI, 54-65%) of the day with esomeprazole 40 mg once daily, arguing that a twice-daily regimen may be the preferred strategy for patients with Barrett's metaplasia.


Aliment Pharmacol Ther


Kahrilas PJ




Has Abstract


2004-10-01 00:00:00


89-94; discussion 95-6








20 Suppl 5


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    更新日期:1998-05-01 00:00:00

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    更新日期:2007-11-15 00:00:00

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    更新日期:2000-11-01 00:00:00

  • Treatment of gastro-oesophageal reflux disease with rabeprazole in primary and secondary care: does Helicobacter pylori infection affect proton pump inhibitor effectiveness?

    abstract:BACKGROUND:The presence of the gastric pathogen, Helicobacter pylori influences acid suppression by proton pump inhibitors and treatment outcome in patients with gastro-oesophageal reflux disease. AIM:To determine the influence of H. pylori infection on effectiveness of rabeprazole in primary and secondary care patien...

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    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Wit NJ,Boer WA,Geldof H,Hazelhoff B,Bergmans P,Tytgat GN,Smout AJ

    更新日期:2004-08-15 00:00:00

  • Serology-based criteria for adult coeliac disease have excellent accuracy across the range of pre-test probabilities.

    abstract:BACKGROUND:The revised paediatric criteria for coeliac disease allow omission of duodenal biopsies in symptomatic children who have specific serology and coeliac disease-associated genetics. It remains unclear whether this approach is also applicable for adults with various clinical presentations. AIM:To evaluate the ...

    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章


    authors: Fuchs V,Kurppa K,Huhtala H,Laurila K,Mäki M,Collin P,Salmi T,Luostarinen L,Saavalainen P,Kaukinen K

    更新日期:2019-02-01 00:00:00

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    abstract:BACKGROUND:Patients with chronic pancreatitis or pancreatic cancer commonly develop exocrine pancreatic insufficiency, and may not be adequately treated with pancreatic enzyme replacement therapy (PERT). AIMS:To estimate the frequency of diagnostic testing for exocrine insufficiency, and appropriate use of PERT, in a ...

    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 杂志文章


    authors: Forsmark CE,Tang G,Xu H,Tuft M,Hughes SJ,Yadav D

    更新日期:2020-05-01 00:00:00

  • NSAID-associated gastroduodenal damage: does famotidine protection extend into the mid- and distal duodenum?

    abstract::Eighteen healthy volunteers were included in a cross-over, double-blind study where 500 mg naproxen b.d. was given for 1 week with 20 mg famotidine b.d., 40 mg nocte or placebo. Endoscopic evaluation of the gastroduodenal mucosa was performed before and after each treatment period, with separate evaluation of the mid-...

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    pub_type: 临床试验,杂志文章


    authors: Aabakken L,Bjørnbeth BA,Weberg R,Viksmoen L,Larsen S,Osnes M

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    pub_type: 杂志文章


    authors: Mönkemüller KE,Hirschowitz BI

    更新日期:1999-05-01 00:00:00

  • Microbiome changes associated with sustained eradication of Clostridium difficile after single faecal microbiota transplantation in children with and without inflammatory bowel disease.

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    authors: Hourigan SK,Chen LA,Grigoryan Z,Laroche G,Weidner M,Sears CL,Oliva-Hemker M

    更新日期:2015-09-01 00:00:00

  • Scintigraphic assessment of the intragastric distribution and gastric emptying of an encapsulated drug: the effect of feeding and of a proton pump inhibitor.

    abstract:BACKGROUND:Local delivery of therapeutic agents to the stomach may be a useful strategy in the treatment of Helicobacter pylori infection. We aimed to see whether the intragastric distribution and gastric retention of a therapeutic agent could be improved, either by giving omeprazole or by dosing after a meal. METHODS...

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    pub_type: 临床试验,杂志文章,随机对照试验


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    journal_title:Alimentary pharmacology & therapeutics

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    更新日期:1999-07-01 00:00:00

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    journal_title:Alimentary pharmacology & therapeutics

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    pub_type: 杂志文章,评审


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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: O'Donohue JW,Pereira SP,Ashdown AC,Haigh CG,Wilkinson JR,Williams R

    更新日期:2005-04-15 00:00:00

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    journal_title:Alimentary pharmacology & therapeutics

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Talley NJ,Riff DS,Schwartz H,Marcuard SP

    更新日期:2001-10-01 00:00:00