pH Profiles in GERD & Barrett's Patients Treated With PPI's
Background: Acid plays a significant role in the development of gastro-oesophageal reflux symptoms and tissue damage. It is generally assumed that acid suppressive therapy with proton pump inhibitors improves or eliminates symptoms of gastro-oesophageal reflux disease by normalizing intra-oesophageal pH. However, the degree of acid suppression induced by proton pump inhibitor therapy in patients with gastro-oesophageal reflux disease and/or Barrett's oesophagus has not been adequately studied.
Aim: To assess the efficacy of proton pump inhibitors in normalizing intra-oesophageal and intra-gastric pH in patients with gastro-oesophageal reflux disease with and without Barrett's oesophagus who have been rendered symptom-free by acid-suppressive therapy.
Methods: Patients with gastro-oesophageal reflux disease and Barrett's oesophagus were prospectively evaluated by dual sensor 24-h pH monitoring while receiving proton pump inhibitor therapy for complete control of gastro-oesophageal reflux disease symptoms. Analyses and comparisons of intra-oesophageal and intra-gastric pH profiles on therapy were then made.
Results: One hundred and ten patients, 98 men and 12 women, with gastro-oesophageal reflux disease (n = 62) and/or Barrett's oesophagus (n = 48), were studied. All tolerated proton pump inhibitors well and were asymptomatic at the time of the study. Thirty-six (58%) patients with gastro-oesophageal reflux disease and 24 (50%) patients with Barrett's oesophagus (P = 0.4) normalized their intra-oesophageal pH profiles on proton pump inhibitors. Compared with patients with gastro-oesophageal reflux disease, patients with Barrett's oesophagus were more likely to have higher degree of pathologic acid reflux despite proton pump inhibitor therapy (DeMeester score 50.5 ± 8.2 vs. 31.4 ± 4.6, P = 0.03) and exhibited less intra-gastric acid suppression (% total pH<4.0: 53.9 ± 2.7 vs. 39.9 ± 2.6, P = 0.0004), particularly supine (% pH<4.0: 62.1 ± 3.4 vs. 44.8 ± 3.4, P = 0.0006).
Conclusions: Gastro-oesophageal reflux disease patients with or without Barrett's oesophagus continue to exhibit pathologic gastro-oesophageal reflux disease and low intra-gastric pH despite proton pump inhibitor therapy that accomplishes complete reflux symptom control. Further, intra-oesophageal and intra-gastric pH control is significantly more difficult to achieve in patients with Barrett's oesophagus. These findings may have significant therapeutic implications.
The widespread use of proton pump inhibitors (PPIs) in the management of gastro-oesophageal reflux disease (GERD) is based on their remarkable efficacy and safety profile. It is now recognized that PPIs heal 80-90% or erosive oesophagitis and provide complete relief of heartburn in about 80% of GERD sufferers. These benefits of PPIs in the therapy of GERD reflect the ability of these drugs to suppress intra-gastric acidity. Indeed, the higher the amount of intra-gastric acid suppression the better the healing rates of oesophagitis. Studies have shown that patients with Barrett's oesophagus (BE) have more oesophageal 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 intra-oesophageal acid levels. In addition, a significant number of BE patients will not demonstrate normalization of oesophageal pH even when taking high-dose PPI therapy.
Currently there are five PPIs for the treatment of GERD. The purpose of this prospective study was to assess the efficacy of PPI therapy in normalizing intra-oesophageal and intra-gastric pH in patients with GERD with and without BE who have been rendered asymptomatic with therapy.
Background: Acid plays a significant role in the development of gastro-oesophageal reflux symptoms and tissue damage. It is generally assumed that acid suppressive therapy with proton pump inhibitors improves or eliminates symptoms of gastro-oesophageal reflux disease by normalizing intra-oesophageal pH. However, the degree of acid suppression induced by proton pump inhibitor therapy in patients with gastro-oesophageal reflux disease and/or Barrett's oesophagus has not been adequately studied.
Aim: To assess the efficacy of proton pump inhibitors in normalizing intra-oesophageal and intra-gastric pH in patients with gastro-oesophageal reflux disease with and without Barrett's oesophagus who have been rendered symptom-free by acid-suppressive therapy.
Methods: Patients with gastro-oesophageal reflux disease and Barrett's oesophagus were prospectively evaluated by dual sensor 24-h pH monitoring while receiving proton pump inhibitor therapy for complete control of gastro-oesophageal reflux disease symptoms. Analyses and comparisons of intra-oesophageal and intra-gastric pH profiles on therapy were then made.
Results: One hundred and ten patients, 98 men and 12 women, with gastro-oesophageal reflux disease (n = 62) and/or Barrett's oesophagus (n = 48), were studied. All tolerated proton pump inhibitors well and were asymptomatic at the time of the study. Thirty-six (58%) patients with gastro-oesophageal reflux disease and 24 (50%) patients with Barrett's oesophagus (P = 0.4) normalized their intra-oesophageal pH profiles on proton pump inhibitors. Compared with patients with gastro-oesophageal reflux disease, patients with Barrett's oesophagus were more likely to have higher degree of pathologic acid reflux despite proton pump inhibitor therapy (DeMeester score 50.5 ± 8.2 vs. 31.4 ± 4.6, P = 0.03) and exhibited less intra-gastric acid suppression (% total pH<4.0: 53.9 ± 2.7 vs. 39.9 ± 2.6, P = 0.0004), particularly supine (% pH<4.0: 62.1 ± 3.4 vs. 44.8 ± 3.4, P = 0.0006).
Conclusions: Gastro-oesophageal reflux disease patients with or without Barrett's oesophagus continue to exhibit pathologic gastro-oesophageal reflux disease and low intra-gastric pH despite proton pump inhibitor therapy that accomplishes complete reflux symptom control. Further, intra-oesophageal and intra-gastric pH control is significantly more difficult to achieve in patients with Barrett's oesophagus. These findings may have significant therapeutic implications.
The widespread use of proton pump inhibitors (PPIs) in the management of gastro-oesophageal reflux disease (GERD) is based on their remarkable efficacy and safety profile. It is now recognized that PPIs heal 80-90% or erosive oesophagitis and provide complete relief of heartburn in about 80% of GERD sufferers. These benefits of PPIs in the therapy of GERD reflect the ability of these drugs to suppress intra-gastric acidity. Indeed, the higher the amount of intra-gastric acid suppression the better the healing rates of oesophagitis. Studies have shown that patients with Barrett's oesophagus (BE) have more oesophageal 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 intra-oesophageal acid levels. In addition, a significant number of BE patients will not demonstrate normalization of oesophageal pH even when taking high-dose PPI therapy.
Currently there are five PPIs for the treatment of GERD. The purpose of this prospective study was to assess the efficacy of PPI therapy in normalizing intra-oesophageal and intra-gastric pH in patients with GERD with and without BE who have been rendered asymptomatic with therapy.
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