Nocturnal acid breakthrough: consequences and confronting

Authors K. Triantafillidis, Maria Mylonaki, F. Georgopoulos.


Nocturnal Acid Breakthrough is defined as the appearance
of gastric acid in the antrum of pH<4 overnight for a period
longer than one hour during the administration of proton
pump inhibitors. The prevalence of this phenomenon ranges
between 69-79% in normal volunteers and patients with
gastroesophageal reflux disease respectively. It typically
appears in the second 6-hour period after the evening dose
of a PPI when patients are sleeping. The significance of
nocturnal acid breakthrough is uncertain despite intense
clinical and laboratory investigation. The available data do
not lead to firm conclusions, so this interesting matter
requires more research in different parts of the world. The
relationship between Helicobacter pylori infection and
nocturnal acid breakthrough both in health and upper GI
disorders disease has not been fully investigated. However,
it seems that the Helicobacter pylori status must be taken
into account when dealing with nocturnal acid breakthrough,
both in patients and normal controls. Despite the fact that
data concerning the exact significance of nocturnal acid
breakthrough are not conclusive it must be stressed that it
is a common phenomenon in proton pump inhibitor therapy.
Although esophageal reflux in not a frequent event, it is
more likely to occur in patients with poor motility, severe
gastroesophageal reflux disease, Barretts esophagus and
scleroderma. It seems that in every day clinical practice,
the administration of a proton pump inhibitor before meals
and ranitidine at bedtime may well be the most cost-effective
method available to control gastroesophageal reflux disease.Key Words: Nocturnal acid breakthrough, Reflux, Gastroesophageal
reflux disease, Helicobacter pylori, Extraesophageal
manifestations of GERD, H2 receptor antagonists,
Proton pump inhibitors
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