Clinical ResearchLong-term effect of H2RA therapy on nocturnal gastric acid breakthrough☆,☆☆
Section snippets
Patients
We prospectively evaluated 23 healthy volunteers and 20 patients with GERD. Patients were recruited to the Center for Swallowing and Esophageal Disorders through an advertisement campaign. All volunteers answered a questionnaire to determine medical histories and demographics. Healthy volunteers complained of no symptoms suggestive of GERD and had normal esophageal acid exposure by 24-hour ambulatory gastroesophageal pH level monitoring. Patients who described symptoms of GERD had either
Demographics
Twenty-three normal volunteers (11 men, 12 women), mean age 32 years (range, 21–51 years), and 20 patients with GERD (14 men, 6 women), mean age 41 years (range, 21–71 years), were enrolled in the study protocol. Three volunteers were dropped because of medication noncompliance. Two volunteers and 4 GERD patients were unable to complete all 5 pH studies successfully. Therefore, complete data was analyzed on 34 participants, 18 normal volunteers and 16 GERD patients. Four of 18 normals had
Discussion
Our findings support earlier conclusions that the addition of an H2RA to twice-daily PPI therapy significantly reduces the appearance of nocturnal gastric acid; however, this phenomenon is temporary for most people. After only 1 week of continuous bedtime H2RA administration, there is a significant reduction in the acid inhibitory effect yielded by ranitidine at 1 day. After 1 month of uninterrupted H2RA therapy, gastric acidity has returned to pre-H2RA levels, and there is no meaningful
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Address reprint requests to: Joel E. Richter, M.D., Department of Gastroenterology, A30, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195. e-mail: [email protected]; fax: (216) 444-9416.
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Supported by an educational grant from Astra-Zeneca and the Borra Family Endowment for Esophageal and Swallowing Disorders.