Skip to main content
SpringerLink
Log in

Dual Ambulatory pH Monitoring in Patients with Gastroesophageal Reflux Rendered Asymptomatic with Proton Pump Inhibitor Therapy

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Studies have suggested that proton pump inhibitor (PPI) therapy in gastroesophageal reflux disease (GERD) achieves high rates of esophageal acid normalization.

Aims

Our aims were to investigate the adequacy of esophageal and gastric acid suppression in reflux patients rendered asymptomatic on optimized PPI therapy.

Methods

We retrospectively analyzed outcomes of dual-sensor, ambulatory 24-h pH monitoring in referred persistent reflux patients rendered asymptomatic on PPI therapy. After optimization, we analyzed esophageal and gastric pH profiles to assess acid suppression and examine differences between PPIs. In patients with repeat studies, comparisons between different PPI doses were made.

Results

Of 172 asymptomatic GERD patients, 75 (43.6 %) achieved symptomatic remission with once-daily dosing PPI, and 97 (56.4 %) patients required twice-daily dosing. Of the entire cohort, 93 (54.1 %) had abnormal and 79 (45.9 %) had normal esophageal pH profiles, with mean percent time pH < 4.0 of 14.3 and 2.4, respectively (p < 0.0001). The percent time esophageal pH was abnormal did not correlate with the percent time gastric pH was abnormal (p = 0.17). Different PPI formulations demonstrated differences in gastric—not esophageal—pH times, with esomeprazole exhibiting superior gastric pH suppression (p < 0.0001). Overall, gastric pH control remained suboptimal, with pH < 4.0 ranging between 30 and 50 %. Among patients with sequential pH studies, those with higher PPI dose had improved esophageal pH profiles (p < 0.01).

Conclusions

In GERD patients rendered asymptomatic on PPI therapy, most continue to experience abnormal esophageal and gastric acid exposure. The efficacy of acid suppression therapy, in certain patients, may be much lower than previously thought.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

GERD:

Gastroesophageal reflux disease

PPI:

Proton pump inhibitor

References

  1. Dent J, El-Serag HB, Wallander MA, et al. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54:710–717.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Sandler RS, Everhart JE, Donowitz M, et al. The burden of selected digestive diseases in the United States. Gastroenterology. 2002;122:1500–1511.

    Article  PubMed  Google Scholar 

  3. El-Serag H, Becher A, Jones R. Systematic review: persistent reflux symptoms on proton pump inhibitor therapy in primary care and community studies. Aliment Pharmacol Ther. 2010;32:720–737.

    Article  CAS  PubMed  Google Scholar 

  4. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308–328.

    Article  PubMed  Google Scholar 

  5. Milkes D, Gerson LB, Triadafilopoulos G. Complete elimination of reflux syptoms does not guarantee normalization of intraesophageal and intragastric pH in patients with gastroesophageal reflux disease (GERD). Am J Gastroenterol. 2004;99:991–996.

    Article  PubMed  Google Scholar 

  6. Grigolon A, Cantù P, Savojardo D, Conte D, Penagini R. Esophageal acid exposure on proton pump inhibitors in unselected asymptomatic gastroesophageal reflux disease patients. J Clin Gastroenterol. 2008;42:969–973.

    Article  CAS  PubMed  Google Scholar 

  7. Robinson M, Maton PN, Rodriguez S, et al. Effects of oral rabeprazole on oesophageal and gastric pH in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 1997;11:973–980.

    Article  CAS  PubMed  Google Scholar 

  8. Charbel S, Khandwala F, Vaezi MF. The role of esophageal pH monitoring in symptomatic patients on PPI therapy. Am J Gastroenterol. 2005;100:283–289.

    Article  PubMed  Google Scholar 

  9. Katzka DA, Paoletti V, Leite V. Prolonged ambulatory pH monitoring in patients with persistent gastroesophageal reflux disease symptoms: testing while on therapy identifies the need for more aggressive anti-reflux therapy. Am J Gastroenterol. 1996;91:2110–2113.

    CAS  PubMed  Google Scholar 

  10. Yeh RW, Gerson LB, Triadafilopoulos G. Efficacy of esomeprazole in controlling reflux symptoms, intraesophageal, and intragastric pH in patients with Barrett’s esophagus. Dis Esophagus. 2003;16:193–198.

    Article  CAS  PubMed  Google Scholar 

  11. Hirano I, Richter JE, Practice parameters Committee of the American College of Gastroenterology. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102:668–685.

    Article  PubMed  Google Scholar 

  12. El-Serag HB, Fitzgerald S, Richardson P. The extent and determinants of prescribing and adherence with acid-reducing medications: a national claims database study. Am J Gastroenterol. 2009;104:2161–2167.

    Article  PubMed  Google Scholar 

  13. Vela MF, Camacho-Lobato L, Srinivasan R, et al. Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology. 2001;120:1599–1606.

    Article  CAS  PubMed  Google Scholar 

  14. Boeckxstaens GE, Smout A. Systematic review: role of acid, weakly acidic and weakly alkaline reflux in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2010;32:334–343.

    Article  CAS  PubMed  Google Scholar 

  15. Hirano I, Richter JE, the practice parameters committee of the American college of gastroenterology. ACG Practice Guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102:668–685.

    Article  PubMed  Google Scholar 

  16. Ours TM, Fackler WK, Richter JE, et al. Nocturnal acid breakthrough: clinical significance and correlation with esophageal acid exposure. Gastroenterol. 2003;98:545–550.

    Google Scholar 

  17. Fackler WK, Ours TM, Vaezi MF, et al. Long-term effect of H2RA therapy on nocturnal gastric acid breakthrough. Gastroenterology. 2002;122:625–632.

    Article  CAS  PubMed  Google Scholar 

  18. Miner P Jr, Katz PO, Chen Y, Sostek M. Gastric acid control with esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole: a five-way crossover study. Am J Gastroenterol. 2003;98:2616–2620.

    Article  CAS  PubMed  Google Scholar 

  19. Gralnek IM, Dulai GS, Fennerty MB, et al. Esomeprazole versus other proton pump inhibitors in erosive esophagitis: a metaanalysis of randomized clinical trials. Clin Gastroenterol Hepatol. 2006;4:1452–1458.

    Article  CAS  PubMed  Google Scholar 

  20. Bell NJ, Burget D, Howden CW, et al. Appropriate acid suppression for the management of gastro-oesophageal reflux disease. Digestion. 1992;51:59–67.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest to disclose.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, M-211, Stanford, CA, 94306, USA

    David Lin & George Triadafilopoulos

Authors
  1. David Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George Triadafilopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George Triadafilopoulos.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, D., Triadafilopoulos, G. Dual Ambulatory pH Monitoring in Patients with Gastroesophageal Reflux Rendered Asymptomatic with Proton Pump Inhibitor Therapy. Dig Dis Sci 60, 1343–1349 (2015). https://doi.org/10.1007/s10620-014-3324-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-014-3324-y

Keywords

Search

Navigation