Esophageal Acidification During Nocturnal Acid-breakthrough with Ilaprazole Versus Omeprazole in Gastroesophageal Reflux Disease.

Esophageal Acidification During Nocturnal Acid-breakthrough with Ilaprazole Versus Omeprazole in Gastroesophageal Reflux Disease.

J Neurogastroenterol Motil. 2016 Sep 1;

Authors: Karyampudi A, Ghoshal UC, Singh R, Verma A, Misra A, Saraswat VA

Abstract
Background/Aims: Though nocturnal acid-breakthrough (NAB) is common in gastroesophageal reflux disease (GERD) patients, its clinical importance results from esophageal acidification, which has been shown to be uncommon. Ilaprazole, a long-acting proton pump inhibitor, may cause NAB infrequently. Accordingly, we studied prospectively, (1) frequency and degree of esophageal acidification during NAB, and (2) frequency and severity of NAB while on ilaprazole versus omeprazole.
Methods: Fifty-eight consecutive patients with GERD on once daily ilaprazole, 10 mg (n = 28) or omeprazole, 20 mg (n = 30) for > one month underwent 24-hour impedance-pH monitoring prospectively. NAB was defined as intra-gastric pH < 4 for > one hour during night and esophageal acidification as pH < 4 for any duration. Nocturnal symptoms (heartburn, regurgitation, and chest pain) were also recorded.
Results: Of 58 patients (age 35.5 [inter-quartile range 26.5-46.0] years, 38 (65.5%) male), 42 (72.4%) had NAB. Though patients with NAB had lower nocturnal intra-gastric pH than without (2.8 [1.9- 4.1] vs 5.7 [4.6-6.8], P < 0.001), frequency and duration of nocturnal esophageal acidification (17/42 vs 4/16, P = 0.36 and 0.0 [0.0-1.0] vs 0.0 [0.0-0.3] minutes, P = 0.26, respectively) and symptoms were comparable (13/42 vs 6/16, P = 0.75). Though ilaprazole was associated with less NABs (1 [range 1-2, n = 19] vs 1 [range 1-3, n = 23], P = 0.01) than omeprazole, frequency, duration, and mean intra-gastric pH during NAB were comparable (19/28 vs 23/30, P = 0.56; 117 [0-315] vs 159 [69-287] minutes, P = 0.5; 1.02 [0.7-1.4] vs 1.04 [0.44-1.3], P = 0.62, respectively).
Conclusions: Though NAB was common while on proton pump inhibitor, esophageal acidification was uncommon. Frequency and severity of NAB were comparable among patients on ilaprazole and omeprazole except for lesser number of NABs.

PMID: 27585842 [PubMed - as supplied by publisher]

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