Normalization of pH in GERD Patients
Normalization of pH in GERD Patients
Background: Acid plays a significant role in the development of gastroesophageal reflux symptoms, such as heartburn and regurgitation. It is generally assumed that acid suppressive therapy improves or eliminates symptoms by normalizing intraesophageal pH.
Aims: The aim of this article was to assess the efficacy of proton-pump inhibitors (PPIs) in normalizing intraesophageal and intragastric pH in patients with GERD without Barrett's esophagus (BE) rendered symptom free by therapy.
Methods: Patients were evaluated by dual-sensor 24-h pH monitoring while receiving PPI therapy for complete control of GERD symptoms. Analyses of intraesophageal and intragastric pH profiles were then made.
Results: Fifty patients, 39 men and 11 women, with GERD, without BE, were studied. All tolerated PPIs well and were asymptomatic at the time of the study. Fifty percent of patients had abnormal intraesophageal pH profiles despite adequate symptom control on PPIs, which was associated with significant breakthrough of intraesophageal acid control in both the upright and supine positions. Low intragastric pH correlated highly with intraesophageal acid reflux only in patients with persistent abnormal esophageal acid exposure (p = 0.001).
Conclusions: Fifty percent of patients with GERD without BE continue to exhibit pathologic GERD and low intragastric pH despite PPI therapy that achieves complete reflux symptom control.
The widespread use of proton-pump inhibitors (PPIs) in the management of gastroesophageal reflux disease (GERD) is based on their remarkable efficacy and safety profile. It is now recognized that PPIs heal 90% of erosive esophagitis and provide complete relief of heartburn in about 60-80% of GERD sufferers. These benefits of PPIs in the therapy of GERD reflect the ability of these drugs to suppress intragastric acidity. Indeed, the higher the amount of intragastric acid suppression the better the healing rates of esophagitis. Studies have shown that patients with Barrett's esophagus (BE) have more esophageal acid exposure than healthy controls or patients with mild GERD. This suggests a significant role for acid reflux in the development and subsequent progression of BE. However, complete elimination of symptoms in patients with BE does not guarantee normalization of intraesophageal acid levels. In addition, a significant number of BE patients will not demonstrate normalization of esophageal pH even when taking high-dose PPI therapy.
Currently there are five PPI for the treatment of GERD. The purpose of this prospective study was to assess the efficacy of PPI therapy in normalizing intraesophageal and intragastric pH in patients with GERD without BE who have been rendered asymptomatic with therapy.
Background: Acid plays a significant role in the development of gastroesophageal reflux symptoms, such as heartburn and regurgitation. It is generally assumed that acid suppressive therapy improves or eliminates symptoms by normalizing intraesophageal pH.
Aims: The aim of this article was to assess the efficacy of proton-pump inhibitors (PPIs) in normalizing intraesophageal and intragastric pH in patients with GERD without Barrett's esophagus (BE) rendered symptom free by therapy.
Methods: Patients were evaluated by dual-sensor 24-h pH monitoring while receiving PPI therapy for complete control of GERD symptoms. Analyses of intraesophageal and intragastric pH profiles were then made.
Results: Fifty patients, 39 men and 11 women, with GERD, without BE, were studied. All tolerated PPIs well and were asymptomatic at the time of the study. Fifty percent of patients had abnormal intraesophageal pH profiles despite adequate symptom control on PPIs, which was associated with significant breakthrough of intraesophageal acid control in both the upright and supine positions. Low intragastric pH correlated highly with intraesophageal acid reflux only in patients with persistent abnormal esophageal acid exposure (p = 0.001).
Conclusions: Fifty percent of patients with GERD without BE continue to exhibit pathologic GERD and low intragastric pH despite PPI therapy that achieves complete reflux symptom control.
The widespread use of proton-pump inhibitors (PPIs) in the management of gastroesophageal reflux disease (GERD) is based on their remarkable efficacy and safety profile. It is now recognized that PPIs heal 90% of erosive esophagitis and provide complete relief of heartburn in about 60-80% of GERD sufferers. These benefits of PPIs in the therapy of GERD reflect the ability of these drugs to suppress intragastric acidity. Indeed, the higher the amount of intragastric acid suppression the better the healing rates of esophagitis. Studies have shown that patients with Barrett's esophagus (BE) have more esophageal acid exposure than healthy controls or patients with mild GERD. This suggests a significant role for acid reflux in the development and subsequent progression of BE. However, complete elimination of symptoms in patients with BE does not guarantee normalization of intraesophageal acid levels. In addition, a significant number of BE patients will not demonstrate normalization of esophageal pH even when taking high-dose PPI therapy.
Currently there are five PPI for the treatment of GERD. The purpose of this prospective study was to assess the efficacy of PPI therapy in normalizing intraesophageal and intragastric pH in patients with GERD without BE who have been rendered asymptomatic with therapy.
