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Nocturnal acid breakthrough: pH, drugs and bugs
Radu Tutuian1, Philip O Katz, Donald O Castell
1Division of Gastroenterology-Hepatology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. tutuianr@musc.edu
European Journal of Gastroenterology & Hepatology
|April 21, 2004
Summary
Nocturnal acid breakthrough (NAB) occurs in over 70% of patients on proton pump inhibitor (PPI) therapy. However, H. pylori-positive patients may not require additional H2RA therapy to manage nighttime acid secretion.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Nocturnal acid breakthrough (NAB) is defined as intragastric pH < 4 for at least 60 minutes overnight in patients on twice-daily proton pump inhibitor (PPI) therapy.
- NAB affects over 70% of patients, but can be managed with histamine-2 receptor antagonists (H2RA).
Purpose of the Study:
- To investigate the influence of Helicobacter pylori status on NAB.
- To evaluate the necessity of combined PPI and H2RA therapy in H. pylori-positive patients.
Main Methods:
- Review of existing data on NAB, PPI therapy, and H. pylori status.
- Analysis of intragastric acid control in H. pylori-positive versus H. pylori-negative patients on PPIs.
Main Results:
- H. pylori-positive patients exhibit better gastric acid control on PPI therapy compared to H. pylori-negative patients.
- NAB may not occur in H. pylori-positive individuals on twice-daily PPIs, potentially negating the need for additional H2RA therapy.
Conclusions:
- H. pylori status is a significant factor in managing nocturnal acid breakthrough during PPI therapy.
- Further research is needed to determine optimal strategies for NAB management, considering H. pylori status and clinical outcomes.
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