| Theme |
PPI Therapy |
| Title |
Long-Term Treatment with PPI and Nocturnal Gastric Acid Breakthrough |
| Author |
Yoshikazu Kinoshita |
Department of Medicine II, Shimane Medical University |
| Author |
Kyoichi Adachi |
Department of Medicine II, Shimane Medical University |
| Author |
Akira Kawamura |
Department of Medicine II, Shimane Medical University |
| [ Summary ] |
Approximately half of the cases treated with proton pump inhibitors(PPI) show incomplete gastric pH control during nocturnal periods. This incomplete control of nocturnal pH during PPI treatment is called nocturnal gastric acid breakthrough (NAB). This phenomenon is caused not by the low acid suppressing capability of PPI during nocturnal periods but by the nocturnal absence of intragastine food, with its consequent buffering action on gastric acid. During PPI treatment, the presence of food in the stomach causes a remarkable, long-lasting increase in intragastric pH levels by buffering gastric acid, secretion which is inhibited down to 10% of the control values for PPI. NAB is frequently observed in cases not associated with Helicobacter pylori (H. pylori) infection. The cases with reflux esophagitis which require long-term maintenance treatment with PPI are usually cases with high grade reflux esophagitis. Since patients with high grade reflux esophagitis have a lower chance of being infected with H. pylori, those patients who need PPI maintenance therapy have a higher chance of exhibiting NAB during PPI maintenance therapy. Therefore, for the treatment of patients with refractory or recurrent reflux esophagitis during PPI maintenance therapy, we should remember the possible involvement of NAB in relation to difficulties with treatment. |