Digestive Diseases and Sciences

, Volume 40, Supplement 2, pp 24S–49S | Cite as

Optimizing acid suppression for treatment of acid-related diseases

  • Richard H. Hunt
  • Christer Cederberg
  • John Dent
  • Fred Halter
  • Colin Howden
  • I. N. Solly Marks
  • Simon Rune
  • Robert P. Walt


Gastric acid is of central importance in the pathogenesis of duodenal ulcer, gastric ulcer, and gastroesophageal reflux disease. Pharmacological reduction of acid secretion is, therefore, the mainstay of current treatment, but the optimal degree of acid suppression remains incompletely understood. This paper considers the ideal ways of assessing and reporting the pharmacological effectiveness of acid-inhibiting drugs and relating such data to clinical efficacy. Twenty-four-hour intragastric pH measurements are widely used for this purpose, although this technique cannot measure secretion quantitatively. Data on suppression of 24-hr intragastric acidity for groups of subjects have been successfully correlated with healing rates for duodenal ulcer, gastric ulcer, and gastroesophageal reflux disease. Three primary determinants of healing have been derived from antisecretory data. These are the degree of suppression of acidity, the duration of suppression of acidity, and the duration of treatment. The order of importance of these determinants varies depending on the disease. Data on 24-hr intragastric acidity should be accompanied whenever possible by data on 24-hr plasma gastrin levels, as the relationship between suppression of acidity and a rise in gastrin varies widely between individuals. It is not possible to predict the plasma gastrin level from the intragastric pH or any other measurement of intragastric acidity. Comparative data sets in groups of subjects may provide useful information. Proton pump inhibitors produce a greater and longer-lasting degree of suppression of acidity than conventional doses of H2-receptor antagonists. For this reason, they are more effective in healing duodenal ulcer and gastric ulcer. However, in view of the importance of duration of treatment, healing rates with the H2-receptor antagonists approach those obtained with proton pump inhibitors if treatment is continued for a longer time. In gastroesophageal reflux disease in particular, although the optimal degree of acid suppression is not yet defined, the consistently superior performance of proton pump inhibitors demonstrates that increased suppression of acidity is clinically beneficial.

Key Words

antisecretory drugs duodenal ulcer gastric ulcer gastroesophageal reflux disease intragastric acidity 


  1. 1.
    Rademaker JW, Hunt RH:Helicobacter pylori and gastric acid secretion: The ulcer link? Scand J Gastroenterol 26(suppl 187):71–77, 1991Google Scholar
  2. 2.
    Osler W: Diseases of the stomach.In The Principles and Practices of Medicine, 6th ed. New York, Appleton, 1905, pp 457–497Google Scholar
  3. 3.
    Hunt RH: Spontaneous hypochlorhydria.In Campylobacter pylori and Gastroduodenal Disease, 2nd ed. Rathbone BJ, Heatley RV (eds). Oxford, Blackwell Scientific, 1992, pp 187–197Google Scholar
  4. 4.
    Cave DR, Vargas M: Effect of aCampylobacter pylori protein on acid secretion by parietal cells. Lancet 2:187–189, 1989Google Scholar
  5. 5.
    Defize J, Goldie J, Hunt RH: Effect ofCampylobacter pylori on acid production by isolated guinea pig cells. Gut 29:A1435, 1988Google Scholar
  6. 6.
    Muller MJ, Hunt RH: Cytokines and peptic ulcer disease. Eur J Gastroenterol Hepatol 5(suppl 3):569–573, 1993Google Scholar
  7. 7.
    Goldschmiedt M, Karnes WE, Feldman M: Relationship betweenHelicobacter pylori (HP) and gastric secretion/serum gastrin concentrations in healthy humans. Gastroenterology 98:A50, 1990Google Scholar
  8. 8.
    Mullin GE, Kalloo AN: DoesHelicobacter pylori infection affect gastric acid secretion? Gastroenterology 98:A92, 1990Google Scholar
  9. 9.
    Levi S, Beardshall K, Haddad G, Playford R, Ghosh P, Calam J:Campylobacter pylori and duodenal ulcers: The gastrin link. Lancet 1:1167–1168, 1989Google Scholar
  10. 10.
    Montbriand JR, Appleman HD, Cotner EK, Nostrant TT, Elta GH: Treatment ofCampylobacter pylori does not alter gastric acid secretion. Am J Gastroenterol 84:1513–1516, 1989Google Scholar
  11. 11.
    Levi S, Beardshall K, Swift I, Foulkes W, Playford R, Ghosh P, Calam J: AntralHelicobacter pylori, hypergastrinaemia and duodenal ulcers: Effect of eradicating the organism. Br Med J 299:1504–1505, 1989Google Scholar
  12. 12.
    McColl KEL, Fullarton GM, el Nujumi AM, Macdonald AM, Dahil S, Hilditchi TE: Serum gastrin and gastric acid status one and seven months after eradication ofHelicobacter pylori in duodenal ulcer patients. Gut 31:A160, 1990Google Scholar
  13. 13.
    Chiba N, Jacobson K, Rademaker JW, Hunt RH: Parietal cell sensitivity—the effect of eradicatingH. pylori in DU patients vs normal volunteers. Gastroenterology 104:A53, 1992Google Scholar
  14. 14.
    El-Omar E, Penman I, Dorrian CA, Ardill JES, McColl KEL: EradicatingH. pylori lowers gastrin mediated acid secretion by 70% in duodenal ulcer patients and by 50% in healthy volunteers. Gastroenterology 104:A491, 1993Google Scholar
  15. 15.
    Smith JTL, Pounder RE, Nwokolo CU, Lanzon-Miller S, Evans DG, Graham DY, Evans DJ Jr: Inappropriate hypergastrinaemia in asymptomatic healthy subjects infected withHelicobacter pylori. Gut 31:522–525, 1990Google Scholar
  16. 16.
    Wagner S, Gebel M, Bär W, Sculler A, Schmidt FW: The significance ofCampylobacter pylori infection on 24-hour intragastric acidity in patients with gastritis and duodenal ulcer disease. Gastroenterology 98:A145, 1990Google Scholar
  17. 17.
    Karnes WE Jr, Ohning GV, Syntik B, Kim SW, Walsh JH: Preservation of pH inhibition of gastrin release in subjects withHelicobacter pylori. Rev Infect Dis 13:S665, 1991Google Scholar
  18. 18.
    Graham DY, Opekun A, Lew GM, Evans DJ Jr, Klein PD, Evans DG: Ablation of exaggerated meal-stimulated gastrin release in duodenal ulcer patients after clearance ofHelicobacter (Campylobacter) pylori infection. Am J Gastroenterol 85:394–398, 1990Google Scholar
  19. 19.
    McColl KEL, Fullarton GM, el Nujumi AM, Macdonald AM, Brown IL, Hilditch TE: Lowered gastrin and gastric acidity after eradication ofCampylobacter pylori in duodenal ulcer. Lancet 2:499–502, 1989Google Scholar
  20. 20.
    McColl KEL, Fullarton GM, Chittajallu R, el Nujumi AM, Macdonald AM, Dahill SW, Hilditch TE: Plasma gastrin, daytime intragastric pH and nocturnal acid output before and at 1 and 7 months after eradication ofHelicobacter pylori in duodenal ulcer subjects. Scand J Gastroenterol 26:339–342, 1991Google Scholar
  21. 21.
    Chittajallu RS, Neithercut WD, Ardill JES, McColl KE:Helicobacter pylori related hypergastrinaemia is not due to elevated antral surface pH, Scand J Gastroenterol 27:218–223, 1992Google Scholar
  22. 22.
    McColl KEL, el Nujumi AM, Dorrian CA, Macdonald AM, Fullarton GM, Harwood J:Helicobacter pylori and hypergastrinaemia during proton pump inhibitor therapy. Scand J Gastroenterol 27:93–97, 1992Google Scholar
  23. 23.
    Teichmann RK, Andress HJ, Gycha S: Immunologic mediated gastrin release. Gastroenterology 84:1333–1337, 1983Google Scholar
  24. 24.
    Golodner EH, Soll AH, Walsh JH, Calam J: Release of gastrin from cultured canine G cells by interferon-γ and tumor necrosis factor-α. Gastroenterology 104:A584, 1993Google Scholar
  25. 25.
    Le AA, Shulkes A, Lambert JR, Lin SK, Tipping P: Effect of tumor necrosis factor alpha (TNF-α) and bombesin on antral mucosal gastrin and somatostatin: Influence ofH. pylori infection. Gastroenterology 104:A586, 1993Google Scholar
  26. 26.
    Hunt RH: pH and Hp—gastric acid secretion andHelicobacter pylori: Implications for ulcer healing and eradication of the organism. Am J Gastroenterol 88:481–483, 1993Google Scholar
  27. 27.
    Iwahi T, Satoh H, Nakao M, Iwasaki T, Yamazaki T, Kubo K, Tamura T, Imada A: Lansoprazole, a novel benzimidazole proton pump inhibitor, and its related compounds have selective activity againstHelicobacter pylori. Antimicrob Agents Chemother 35:490–496, 1991Google Scholar
  28. 28.
    Nagata K, Satoh H, Iwahi T, Shimoyama T, Tamura T: Potent inhibitory action of the gastric proton pump inhibitor lansoprazole against urease activity ofHelicobacter pylori: Unique action selective forH. pylori cells. Antimicrob Agents Chemother 37:769–774, 1993Google Scholar
  29. 29.
    McNulty CAM, Dent JC, Ford GA Wilkinson SP: Inhibitory antimicrobial concentrations againstCampylobacter pylori in gastric mucosa. J Antimicrob Chemother 22:729–738, 1988Google Scholar


  1. 1.
    Blum AL: Treatment of acid-related disorders with gastric acid inhibitors: The state of the art. Digestion 47(suppl 1): 3–10, 1990Google Scholar
  2. 2.
    Feldman M, Burton ME: Histamine2-receptor antagonists. Standard therapy for acid-peptic diseases. N Engl J Med 323:1672–1680, 1990Google Scholar
  3. 3.
    Howden CW, Hunt RH: Relationship between gastric secretion and infection. Gut 28:96–107, 1987Google Scholar
  4. 4.
    Ruddell WSJ, Axon ATR, Findlay JM, Bartholomew BA, Hill MJ: Effect of cimetidine on gastric bacterial flora. Lancet 1:672–674, 1980Google Scholar
  5. 5.
    Stockbrügger RW, Cotton PB, Eugenides N, Bartholomew BA, Hill MJ, Walters CL: Intragastric nitrites, nitrosamines, and bacterial overgrowth during cimetidine treatment. Gut 23:1048–1054, 1982Google Scholar
  6. 6.
    Walsh JH: The role of gastrin as a trophic hormone. Digestion 47(suppl 1):11–16, 1990Google Scholar
  7. 7.
    Müller J, Kirchner T, Müller-Hermelink HK: Gastric endocrine cell hyperplasia and carcinoid tumors in atrophic gastritis type A. Am J Surg Pathol 11:909–917, 1987Google Scholar
  8. 8.
    Caygill CPJ, Hill MJ, Hall CN, Kirkham JS, Northfield TC: Increased risk of gastric cancer at multiple sites after gastric surgery for peptic ulcer. Gut 28:924–928, 1987Google Scholar
  9. 9.
    Baron JH: Clinical Tests of Gastric Secretion—History, Methodology and Interpretation. London, MacMillan, 1978Google Scholar
  10. 10.
    Vallot T, Mignon M, Mazure R, Bonfils S: Evaluation of antisecretory drug therapy of Zollinger-Ellison syndrome (ZES) using 24-hour pH monitoring. Dig Dis Sci 28:577–584, 1983Google Scholar
  11. 11.
    Jensen RT, Gardner JD, Raufman JP, Pandol SJ, Doppman JL, Collen MJ: Zollinger-Ellison syndrome: Current concepts and management. Ann Intern Med 98:59–75, 1983Google Scholar
  12. 12.
    Watkinson G: A study of the changes of pH of gastric content in peptic ulcer healing using the twenty-four hour test meal. Gastroenterology 18:377–390, 1951Google Scholar
  13. 13.
    Pounder RE, Williams JG, Milton-Thompson GJ, Misiewicz JJ: Twenty-four hour control of intragastric acidity by cimetidine in duodenal-ulcer patients. Lancet 2:1069–1072, 1975Google Scholar
  14. 14.
    Fimmel CJ, Etienne A, Cilluffo T, von Ritter C, Gasser T, Rey J-P, Caradonna-Moscatelli P, Sabbatini F, Pace F, Bühler HW, Bauerfeind P, Blum AL: Long-term ambulatory gastric pH monitoring: Validation of a new method and effect of H2-antagonists. Gastroenterology 88:1842–1851, 1985Google Scholar
  15. 15.
    Chiverton SG, Salena BJ, Burget DW, Hunt RH: Do hourly averaged pH readings correlate with those from point readings of aspiration? Comparison of two different electrode positions with simultaneous aspiration. Dig Dis Sci 8(suppl 1):31–37, 1990Google Scholar
  16. 16.
    Savarino V, Mela GS, Scalabrini P, Magnolia MR, Percario G, Di Timoteo E, Celle G: 24-hour comparison between pH values of continuous intraluminal recording and simultaneous gastric aspiration. Scand J Gastroenterol 22:135–140, 1987Google Scholar
  17. 17.
    Reynolds JR, Walt RP, Hardcastle JD, Clark AG, Smart HL, Langman MJS: 24-hour intragastric pH: continuous monitoring or nasogastric aspiration? Digestion 33:219–224, 1986Google Scholar
  18. 18.
    Merki H, Witzel L, Walt RP, Cohnen E, Herre K, Heim J, Mappes A, Röhmel J: Day-to-day variation of 24-hour intragastric acidity. Gastroenterology 94:887–891, 1988Google Scholar
  19. 19.
    McLauchlan G, Fullarton GM, Crean GP, McColl KEL: Comparison of gastric body and antral pH: A 24 hour ambulatory study in healthy volunteers. Gut 30:573–578, 1989Google Scholar
  20. 20.
    Eriksen CA, Sadek SA, Cuschieri A: 24-hour ambulatory dual gastroduodenal pH monitoring. The role of acid in duodenal ulcer disease. Ann Surg 208:702–707, 1988Google Scholar
  21. 21.
    Bendtsen F, Rosenkilde-Gram B, Tage-Jensen U, Ovesen L, Rune SJ: Duodenal bulb acidity in patients with duodenal ulcer. Gastroenterology 93:1263–1269, 1987Google Scholar
  22. 22.
    McCloy RF, Greenberg GR, Baron JH: Duodenal pH in health and duodenal ulcer disease: Effect of a meal Coca-Cola, smoking, and cimetidine. Gut 25:386–392, 1984Google Scholar
  23. 23.
    Nordgren B: The rate of secretion and electrolyte content of normal gastric juice. Acta Physiol Scand 58(suppl 202):1–83, 1963Google Scholar
  24. 24.
    Bianchi-Porro G, Prada A, Petrillo M, Grossi M: Inhibition of pentagastrin and insulin-stimulated gastric secretion by pirenzepine in healthy and duodenal ulcer subjects. Scand J Gastroenterol 14(suppl 57):63–67, 1979Google Scholar
  25. 25.
    Walt R: 24 hour intragastric acidity—analysis for the future. Gut 27:1–9, 1986Google Scholar
  26. 26.
    Mela GS, Savarino V, Sumberaz A, Bonifacino G, Zentilin P, Villa G, Caputo E: Continuous acidity monitoring in the study of gastric antisecretory drugs: pH or antilog transformation of pH, mean or median? Am J Gastroenterol 85:1105–1108, 1990Google Scholar
  27. 27.
    Röchmel J, Merki HS, Wilder-Smith CH, Walt RP: Analysis and statistical evaluation of continuous pH recordings. Dig Dis 8(suppl 1):87–96, 1990Google Scholar
  28. 28.
    Fiorucci S, Santucci L, Farroni F, Pelli MA, Morelli A: Effect of omeprazole on gastroesophageal reflux in Barrett's esophagus. Am J Gastroenterol 84:1263–1267, 1989Google Scholar
  29. 29.
    Gillen P, Keeling P, Byrne PJ, Hennessy TP: Barrett's oesophagus: pH profile. Br J Surg 74:774–776, 1987Google Scholar
  30. 30.
    Robertson D, Aldersley M, Shepherd H, Smith CL: Patterns of acid reflux in complicated oesophagitis. Gut 28:1484–1488, 1987Google Scholar
  31. 31.
    Schindlbeck NE, Heinrich C, König A, Dendorfer A, Pace F, Müller-Lissner SA: Optimal thresholds, sensitivity, and specificity of long-term pH-metry for the detection of gastroesophageal reflux disease. Gastroenterology 93:85–90, 1987Google Scholar
  32. 32.
    Wyman JB, Dent J, Wyman BP, Tippett MD, Holloway RH: Are traditional pH criteria for gastro-esophageal reflux accurate? Gastroenterology 100:A186, 1991Google Scholar
  33. 33.
    Bell NJV, Burget D, Howden CW, Wilkinson J, Hunt RH: Appropriate acid suppression for the management of gastro-oesophageal reflux disease. Digestion 51(suppl 1):59–67, 1992Google Scholar
  34. 34.
    Wiener GJ, Morgan TM, Copper JB, Wu WC, Castell DO, Sinclair JW, Richter JE: Ambulatory 24-hour esophageal pH monitoring: reproducibility and variability of pH parameters. Dig Dis Sci 33:1127–1133, 1988Google Scholar
  35. 35.
    Murphy DW, Yuan Y, Castell DO: Does the intraesophageal pH probe accurately detect acid reflux? Simultaneous recording with two pH probes in humans. Dig Dis Sci 34:649–656, 1989Google Scholar
  36. 36.
    Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, Petrie DJ: Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. J Clin Invest 65:256–267, 1980Google Scholar
  37. 37.
    Shaker R, Dodds WJ, Helm JF, Hogan WJ, Arndorfer RC: Regional esophageal distribution and clearance of refluxed acid. Gastroenterology 92:A1635, 1987Google Scholar
  38. 38.
    Shaker R, Helm JF, Dodds WJ, Hogan WJ: Revelations about ambulatory esophageal pH monitoring. Gastroenterology 94:A421, 1988Google Scholar
  39. 39.
    White WD, Juniper K Jr: Repeatability og gastric analysis. Am J Dig Dis 18:7–13, 1973Google Scholar
  40. 40.
    Feldman M, Richardson CT: Gastric acid secretion in humans.In Physiology of the Gastrointestinal Tract. Johnson LR (ed). New York, Raven, 1981, pp 693–707Google Scholar
  41. 41.
    Lind T, Cederberg C, Ekenved G, Olbe L: Inhibition of basal and betazole- sham-feeding-induced acid secretion by omeprazole in man. Scand J Gastroenterol 21:1004–1010, 1986Google Scholar
  42. 42.
    Sharma B, Axelson M, Pounder RP, Lundborg P, Öhman M, Santana A, Talbot M, Cederberg C: Acid secretory capacity and plasma gastrin concentration after administration of omeprazole to normal subjects. Aliment Pharmacol Ther 1:67–76, 1987Google Scholar
  43. 43.
    Wormsley KG, Grossman MI: Maximal histalog test in control subjects and patients with peptic ulcer. Gut 6:427–435, 1965Google Scholar
  44. 44.
    Makhlouf GM, McManus JPA, Card WI: A comparative study of the effects of gastrin, histamine, histalog, and mechothane on the secretory capacity of the human stomach in two normal subjects over 20 months. Gut 6:525–534, 1965Google Scholar
  45. 45.
    Marks IN, Bank S, Louw JH, van Embden BH: The augmented histamine test—an analysis of 672 consecutive tests. S Afr Med J 36:807–812, 1962Google Scholar
  46. 46.
    Marks IN, Shay H: Augmented histamine test, Ewald test meal and Diagnex test-comparison of results. Am J Dig Dis 5:1–23, 1960Google Scholar
  47. 47.
    Card WI, Marks IN, Sircus W: Observations on achlorhydria. J Physiol 130:18P, 1955Google Scholar
  48. 48.
    Callender ST, Retief FP, Witts LJ: The augmented histamine test with special reference to achlorhydria. Gut 1:326–336, 1960Google Scholar
  49. 49.
    Card WI, Sircus W: Anacidity.In Modern Trends in Gastroenterology. Avery Jones F (ed). London, Butterworth, 1952, pp 380–388Google Scholar
  50. 50.
    Walt RP, Gomes M de FA, Wood EC, Logan LH, Pounder RE: Effect of daily oral omeprazole on 24-hour intragastric acidity. Br Med J 287:12–14, 1983Google Scholar
  51. 51.
    Holt P, Rosenberg III, Russell RM: Causes and consequences of hypochlorhydria in the elderly. Dig Dis Sci 34:933–937, 1989Google Scholar
  52. 52.
    Vanzant FR, Alvarez WC, Eusterman GB, Dunn HL, Berkson J: The normal range of gastric acidity from youth to old age—an analysis of 3,746 records. Arch Intern Med 49:345–359, 1932Google Scholar
  53. 53.
    Christiansen PM: The incidence of achlorhydria and hypochlorhydria in healthy subjects and patients with gastrointestinal diseases. Scand J Gastroenterol 3:497–508, 1968Google Scholar
  54. 54.
    Baron JH: Lean body mass, gastric acid and peptic ulcer. Gut 10:637–642, 1969Google Scholar
  55. 55.
    Grossman MI, Kirsner JB, Gillespie IE: Basal and histalog-stimulated gastric secretion in control subjects and in patients with peptic ulcer or gastric cancer. Gastroenterology 45:14–26, 1963Google Scholar
  56. 56.
    Kirsner JB, Ford H: The gastric secretory response to Histalog: One-hour basal and Histalog secretion in normal persons and in patients with duodenal ulcer and gastric ulcer. J Lab Clin Med 46:307–311, 1955Google Scholar
  57. 57.
    Wormsley KG, Grossman MI: Maximal Histalog test in control subjects and patients with peptic ulcer. Gut 6:427–435, 1965Google Scholar
  58. 58.
    Cleator IGM, Stoller JL, Numm PN, Holubitsky IB, Johnstone FRC, Harrison RC: Discriminant analysis of data in ulcer and non-ulcer populations. Am J Dig Dis 18:301–310, 1973Google Scholar
  59. 59.
    Goldschmeidt M, Barnett CC, Schwarz BE, Karnes WE, Redfern JS, Feldman M: Effect of age on gastric acid secretion and serum gastrin concentrations in healthy men and women. Gastroenterology 101:977–990, 1991Google Scholar
  60. 60.
    Ihamäki T, Saukkonen M, Siurala M: Long-term observation of subjects with normal mucosa and with superficial gastritis: results of 23–27 years' follow-up examination. Scand J Gastroenterol 13:771–775, 1978Google Scholar
  61. 61.
    Kekki M, Samloff IM, Ihamäki T, Varis K, Siurala M: Age- and sex-related behaviour of gastric acid secretion at the population level. Scand J Gastroenterol 17:737–743, 1982Google Scholar
  62. 62.
    Christiansen PM, Johansen Å: Single gastric biopsy in subjects with low acid secretion after maximal histamine stimulation. Scand J Gastroenterol 1:86–93, 1966Google Scholar
  63. 63.
    Desai HG, Borkar AV, Jeejeebhoy KN: Correlation between gastric acid secretion and histology in Indian subjects. Scand J Gastroenterol 3:509–512, 1968Google Scholar
  64. 64.
    Goyal RK, Puri SK, Chuttani HK: Mucosal morphology and acid secretory capacity of the stomach in hookworm anemia. Gastroenterology 54:922–928, 1968Google Scholar
  65. 65.
    Trey G, Marks IN, Novis BH, Bax G, Breetzke K, Chipps B, Wells K, Wardle N, Jedeiken L, Mitchell P, Burman N, Erskine W, Tigler-Wybrandi N: Does acid secretion change with aging? A 30 year follow-up study. S Afr Med J 80:54(A), 1991Google Scholar
  66. 66.
    Havu N, Maaroos H-I, Sipponen P: Argyrophil cell hyperplasia associated with chronic corpus gastritis in gastric ulcer disease. Scand J Gastroenterol 26(suppl 186):90–94, 1991Google Scholar
  67. 67.
    Rauws EAJ, Tytgat GNJ: Cure of duodenal ulcer associated with eradication ofHelicobacter pylori. Lancet 335:1233–1235, 1990Google Scholar
  68. 68.
    Tytgat GNJ, Axon ATR, Dixon MF, Graham DY, Lee A, Marshall BJ:Helicobacter pylori: Causal agent in peptic ulcer disease? Working Party Report of the World Congresses of Gastroenterology. Oxford, Blackwell Scientific Publications, 1990, pp 36–45Google Scholar
  69. 69.
    Parsonnet J, Friedman GD, Vandersteen DP, Chang Y, Vogelman JH, Orentreich N, Sibley RK:Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med 25:1127–1131, 1991Google Scholar
  70. 70.
    Nomura A, Stemmermann GN, Chyou P-H, Kato I, Perez-Perez GI, Blaser MJ:Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med 325:1132–1136, 1991Google Scholar
  71. 71.
    Dixon MF: Reflux gastritis. Acta Gastroenterol Belg 52:292–296, 1989Google Scholar
  72. 72.
    Fong T-L, Dooley CP, Dehesa M, Cohen H, Carmel R, Fitzgibbons PL, Perez-Perez GI, Blaser MJ:Helicobacter pylori infection in pernicious anemia: A prospective controlled study. Gastroenterology 100:328–332, 1991Google Scholar
  73. 73.
    Unge P, Gad A, Gnarpe H, Olsson J: Does omeprazole improve antimicrobial therapy directed towards gastricCampylobacter pylori in patients with antral gastritis? Scand J Gastroenterol 24(suppl 167):49–54, 1989Google Scholar
  74. 74.
    Bayerdörffer E, Mannes GA, Sommer A, Höchter W, Weingart J, Hatz R, Lehn N, Ruckdeschel G, Dirschedl P, Stolte M: High omeprazole treatment combined with amoxicillin eradicatesHelicobacter pylori. Eur J Gastroenterol Hepatol 4:697–702, 1992Google Scholar
  75. 75.
    Levi S, Beardshall K, Swift I, Foulkes W, Playford R, Ghosh P, Calam J: AntralHelicobacter pylori, hypergastrinemia, and duodenal ulcers: Effect of eradicating the organism. Br Med J 299:1504–1505, 1989Google Scholar
  76. 76.
    Graham DY, Opekun A, Lew GM, Evans DJ Jr, Klein PD, Evans DG: Ablation of exaggerated meal-stimulated gastrin release in duodenal ulcer patients after clearance ofHelicobacter (Campylobacter) pylori infection. Am J Gastroenterol 85:394–398, 1990Google Scholar
  77. 77.
    Chittajallu RS, Ardill JES, McColl KEL: The degree of hypergastrinaemia induced byHelicobacter pylori is the same in duodenal ulcer patients and asymptomatic volunteers. Eur J Gastroenterol Hepatol 4:49–53, 1992Google Scholar
  78. 78.
    Chittajallu RS, Dorrian CA, Neithercut WD, Daghill S, McColl KEL: IsHelicobacter pylori associated hypergastrinaemia due to the bacterium's urease activity or the antral gastritis? Gut 32:1286–1290, 1991Google Scholar
  79. 79.
    Harume K, Sumii K, Okamoto S, Yosihara M, Tari A, Teixera CR, Takehara Y, Sumii M, Hou W, Kishimoto S, Kajiyama G:Helicobacter pylori infection causes low antral somatostatin content: Pathogenesis of inappropriate hypergastrinemia. Gastroenterology 102:A80, 1992Google Scholar
  80. 80.
    Murty UK, Linscheer R, Co C: The hypergastrinemia inHelicobacter pylori gastritis is due to a decrease in antral D-cell density and D:G cell ratio. Gastroenterology 102:A130, 1992Google Scholar
  81. 81.
    Moss SF, Legon S, Bishop AE, Polak JM, Calam J: Effect ofHelicobacter pylori on gastric somatostatin in duodenal ulcer patients. Lancet 340:930–932, 1992Google Scholar
  82. 82.
    Hunt RH: Spontaneous hypochlorhydria.In Campylobacter pylori and Gastroduodenal Disease, 2nd ed. Rathbone BJ, Heatley RV (eds). Oxford, Blackwell, 1992, pp 187–197Google Scholar
  83. 83.
    Rademaker JW, Hunt RH:H. pylori and gastric acid secretion: The ulcer link. Scand J Gastroenterol 26(suppl 187):71–77, 1991Google Scholar
  84. 84.
    McColl KE, Fullarton GM, El Nujumi AM, MacDonald AMI, Hilditch TE, Dahil S: Serum gastrin and gastric acid status one and seven months after eradication ofH. pylori in duodenal ulcer patients. Gut 31:A601, 1990Google Scholar
  85. 85.
    Piper DW, Raine JM: Effect of smoking on gastric secretion. Lancet 1:696–698, 1959Google Scholar
  86. 86.
    Whitfield PF, Hobsley M: Comparison of maximal gastric secretion in smokers and non-smokers with and without duodenal ulcer. Gut 28:557–560, 1987Google Scholar
  87. 87.
    Bynum TE, Solomon TE, Johnson LR, Jacobson ED: Inhibition of pancreatic secretion in man by cigarette smoking. Gut 13:361–365, 1972Google Scholar
  88. 88.
    Bocheneck WJ, Koronczeski R: Effects of cigarette smoking on bicarbonate and volume of duodenal contents. Am J Dig Dis 18:729–733, 1973Google Scholar
  89. 89.
    Murthy SNS, Dinoso VP Jr, Clearfield HR, Chey WY: Simultaneous measurement of basal pancreatic, gastric acid secretion, plasma gastrin, and secretin during smoking. Gastroenterology 73:758–761, 1977Google Scholar
  90. 90.
    Chiverton SG, Hunt RH: Smoking and duodenal ulcer disease. J Clin Gastroenterol 11(suppl 1):S29-S33, 1989Google Scholar
  91. 91.
    Kaufmann D, Wilder-Smith CH, Kempf M, Neumann J, Schmolls H, Witzel L, Walt RP, Röhmel J, Merki HS: Cigarette smoking, gastric acidity and peptic ulceration. What are the relationships? Dig Dis Sci 35:1482–1487, 1990Google Scholar
  92. 92.
    Korman MG, Shaw RG, Hansky UJ, Schmidt GT, Stern AI: Influence of smoking on healing rate of duodenal ulcer in response to cimetidine or high-dose antacid. Gastroenterology 80:1451–1453, 1981Google Scholar
  93. 93.
    Boyd EJS, Johnston DA, Wormsley KG, Jenner WN, Salanson X: The effects of cigarette smoking on plasma concentrations of gastric antisecretory drugs. Aliment Pharmacol Ther 1:57–65, 1987Google Scholar
  94. 94.
    Bauerfeind P, Cilluffo T, Fimmel CJ, Emde C, Von Ritter C, Kohler W, Gugler R, Gasser T, Blum AL: Does smoking interfere with the effect of histamine H2-receptor antagonists on intragastric acidity in man? Gut 28:549–556, 1987Google Scholar
  95. 95.
    Deakin M, Ramage J, Gray SP, Billings J, Colin-Jones D, Williams JG: Smoking, gastric secretion, and inhibition by H2-receptor antagonists. Lancet 1:1049, 1985 (letter)Google Scholar
  96. 96.
    Schürer-Maly C-C, Varga L, Koelz HR, Halter F: Smoking and pH response to H2-receptor antagonists. Scand J Gastroenterol 24:1172–1178, 1989Google Scholar
  97. 97.
    Kikendall JW, Evaul J, Johnson LF: Effect of cigarette smoking on gastrointestinal physiology and non-neoplastic digestive disease. J Clin Gastroenterol 6:65–79, 1984Google Scholar
  98. 98.
    Derodra JK, Burget DW, Hunt RH: Effects of oral nicotine on the formation of acetic acid induced gastric and duodenal ulcers. Gastroenterology 92:1369, 1987Google Scholar
  99. 99.
    Katschinski BD, Goebell H, Arnold R, Classen M, Fischer M, Witzel L, Blum AL, RUDER Study Group: Smoking as a risk factor for slow duodenal ulcer healing. Eur J Gastroenterol Hepatol 3:443–447, 1991Google Scholar
  100. 100.
    McCready DR, Clark L, Cohen MM: Cigarette smoking reduces human gastric luminal prostaglandin E2. Gut 26:1192–1196, 1985Google Scholar
  101. 101.
    Maxton DG, Srivastava ED, Whorwell PJ, Jones DM: Do nonsteroidal anti-inflammatory drugs or smoking predispose toHelicobacter pylori infection? Postgrad Med J 66:717–719, 1990Google Scholar
  102. 102.
    George L, Hyland L, Morgan A, Cole P, Andrews P, Brandl S, Borody T: Smoking does not contribute to duodenal ulcer relapse afterHelicobacter pylori eradication. Am J Gastroenterol 87:1390–1393, 1992Google Scholar
  103. 103.
    Feldman M, Colturi TJ: Effect of indomethacin on gastric acid and bicarbonate secretion in humans. Gastroenterology 87:1339–1343, 1984Google Scholar
  104. 104.
    Walt RP, Daneshmend TK, Prichard P, Langman MJS: Effect of ranitidine and indomethacin on nocturnal gastric acidity in normal subjects. Aliment Pharmacol Ther 4:171–176, 1990Google Scholar
  105. 105.
    Rademaker JW, McDonald T, Chiba N, Hunt RH: Effect of NSAIDs induced gastric mucosal injury on intragastric pH and gastrin profiles in healthy volunteers. Gut 32:A1221, 1991Google Scholar
  106. 106.
    Robinson MG, Griffin JW Jr, Bowers J, Kogan FJ, Kogut DG, Lanza FL, Warner CW: Effect of ranitidine on gastroduodenal mucosal damage induced by nonsteroidal anti-inflammatory drugs. Dig Dis Sci 34:424–428, 1989Google Scholar
  107. 107.
    Ehsanullah RSB, Page MC, Tildeley G, Wood JR: Prevention of gastroduodenal damage induced by non-steroidal anti-inflammatory drugs: Controlled trial of ranitidine. Br Med J 297:1017–1021, 1988Google Scholar
  108. 108.
    Lancaster-Smith MJ, Jaderberg ME, Jackson DA: Ranitidine in the treatment of non-steroidal anti-inflammatory drug associated gastric and duodenal ulcers. Gut 32:252–255, 1991Google Scholar
  109. 109.
    Walan A, Bader J-P, Classen M, Lamers CBHW, Piper DW, Rutgersson K, Eriksson S: Effect of omeprazole and ranitidine on ulcer healing and relapse rates in patients with benign gastric ulcer. N Engl J Med 320:69–75, 1989Google Scholar
  110. 110.
    Danish Omeprazole Study Group: Omeprazole and cimetidine in the treatment of ulcers of the body of the stomach: a double blind comparative trial. Br Med J 298:645–647, 1989Google Scholar
  111. 111.
    Holtmann G, Singer MV, Kriebel R, Stacker KH, Goebell H: Differential effects of acute mental stress on interdigestive secretion of gastric acid, pancreatic enzymes, and gastroduodenal motility. Dig Dis Sci 34:1701–1707, 1989Google Scholar
  112. 112.
    Holtmann G, Kriebel R, Singer MV: Mental stress and gastric acid secretion—do personality traits influence the response? Dig Dis Sci 35:998–1007, 1990Google Scholar
  113. 113.
    Peters MN, Richardson CT: Stressful life events, acid hypersecretion, and ulcer disease. Gastroenterology 84:114–119, 1983Google Scholar
  114. 114.
    Wormsley KG: Aetiology of ulcers.In Peptic Ulceration. Baillière's Clinical Gastroenterology. Vol 2. No 3. Piper DW (ed). London, Baillière Tindall, 1988, pp 555–571Google Scholar
  115. 115.
    Klein KB, Spiegel D: Modulation of gastric acid secretion by hypnosis. Gastroenterology 96:1383–1387, 1989Google Scholar
  116. 116.
    Colgan SM, Faragher EB, Whorwell PJ: Controlled trial of hypnotherapy in relapse prevention of duodenal ulceration. Lancet 1:1299–1300, 1988Google Scholar
  117. 117.
    Li V, Hostein J, Romero NB, Marsac C, Mezin P, Bost R, Degoul F, Fardeau M, Fournet J: Chronic intestinal pseudoobstruction with myopathy and ophthalmoplegia. A muscular biochemical study of a mitochondrial disorder. Dig Dis Sci 37:456–463, 1992Google Scholar
  118. 118.
    Tougas G, Li YY, Rademaker JW, Chiverton SG, Hunt RH: The effect of acupuncture on gastric acid secretion in healthy male volunteers. Dig Dis Sci 37:1576–1582, 1992Google Scholar
  119. 119.
    Dragstedt LR, Owens FM Jr: Supradiaphragmatic section of the vagus nerves in treatment of duodenal ulcer. Proc Soc Exp Biol Med 53:152–154, 1943Google Scholar
  120. 120.
    Dragstedt LR: Gastric secretion tests. Gastroenterology 52:587–589, 1967Google Scholar
  121. 121.
    Baron JH: The relationship between basal and maximum acid output in normal subjects and patients with duodenal ulcer. Clin Sci 24:357–370, 1963Google Scholar
  122. 122.
    Howden CW, Jones DB, Burget DW, Hunt RH: Comparison of the effects of gastric antisecretory agents in healthy volunteers and patients with duodenal ulcer. Gut 27:1058–1061, 1986Google Scholar
  123. 123.
    Feldman M, Richardson CT: Total 24-hour gastric acid secretion in patients with duodenal ulcer. Comparison with normal subjects and effects of cimetidine and parietal cell vagotomy, Gastroenterology 90:540–544, 1986Google Scholar
  124. 124.
    Merki HS, Fimmel CJ, Walt RP, Harre K, Röhmel J, Witzel L: Pattern of 24-hour intragastric acidity in active duodenal ulcer disease and in healthy controls. Gut 29:1583–1587, 1988Google Scholar
  125. 125.
    Gledhill T, Howard OM, Buck M, Paul A, Hunt RH: Single nocturnal dose of an H2 receptor antagonist for the treatment of duodenal ulcer. Gut 24:904–908, 1983Google Scholar
  126. 126.
    Lucke W, Marks IN, Adams G, Newton K, Wallace I: Comparison of nocturnal with morning dose of ranitidine 300 mg in short-term duodenal ulcer healing, S Afr Med J 75(suppl June 3):11, 1989Google Scholar
  127. 127.
    Zaterka S, Massuda HK, Eisig JN, Chinzon D, Bettarello A: Is the inhibition of nocturnal gastric acid secretion the most important factor in duodenal ulcer treatment? A comparison between the effectiveness of single morning and nocte doses of ranitidine 300 mg. Rev Hosp Clin Fac Med Sao Paulo 44:185–188, 1989Google Scholar
  128. 128.
    Bianchi Porro G, Parente F, Sangaletti O: Inhibition of nocturnal acidity is important but not essential for duodenal ulcer healing. Gut 31:397–400, 1990Google Scholar
  129. 129.
    Bianchi-Porro G, Parente F: Single morning dose versus bedtime dose of ranitidine in duodenal ulcer healing. Hepato-Gastroenterol 35:44, 1988Google Scholar
  130. 130.
    de Pretis G, Dobrilla G, Ferrari A, Fontana G, Maiolo P, Marenco G, Menardo G, Pallini P, Rossini FP, Saggioro A: Comparison between single morning and bedtime doses of 40 mg famotidine for the treatment of duodenal ulcer. Aliment Pharmacol Ther 3:285–291, 1989Google Scholar
  131. 131.
    Andersson S, Grossman MI: Profile of pH, pressure and potential difference at gastroduodenal junction in man. Gastroenterology 49:364–371, 1965Google Scholar
  132. 132.
    Ovesen L, Bendtsen F, Tage-Jensen U, Pedersen NT, Gram BR, Rune SJ: Intraluminal pH in the stomach, duodenum, and proximal jejunum in normal subjects and patients with exocrine pancreatic insufficiency. Gastroenterology 90:958–962, 1986Google Scholar
  133. 133.
    Bendtsen F, Rune SJ: Effect of a single dose of antacid on gastric and duodenal bulb pH in duodenal ulcer patients. Scand J Gastroenterol 23:935–940, 1988Google Scholar
  134. 134.
    Isenberg JI, Selling JA, Hogan DL, Koss MA: Impaired proximal duodenal mucosal bicarbonate secretion in patients with duodenal ulcer. N Engl J Med 316:374–379, 1987Google Scholar
  135. 135.
    Quigley EMM, Turnberg LA: pH of the microclimate lining human gastric and duodenal mucosain vivo. Studies in control subjects and in duodenal ulcer patients. Gastroenterology 92:1876–1884, 1987Google Scholar
  136. 136.
    Yokota H, Yanaka A, Muto H: Impaired neutralizing capacity of duodenal mucosa after luminal acidification in recurrent duodenal ulcer. Gastroenterology 96:A560, 1989Google Scholar
  137. 137.
    Vattay P, Feil W, Klimesch S, Wenzl E, Starlinger M, Schiessel R: Acid stimulated alkaline secretion in the rabbit duodenum is passive and correlates with mucosal damage. Gut 29:284–290, 1988Google Scholar
  138. 138.
    Odes HS, Hogan DL, Ballesteros MA, Wolosin JD, Koss MA, Isenberg JI: Human duodenal mucosal bicarbonate secretion. Evidence suggesting active transport under basal and stimulated conditions. Gastroenterology 98:867–872, 1990Google Scholar
  139. 139.
    Grossman MI, Kirsner JB, Gillespie IE: Basal and histalogstimulated gastric secretion in control subjects and in patients with peptic ulcer or gastric cancer. Gastroenterology 45:14–26, 1963Google Scholar
  140. 140.
    Lanzon-Miller S, Pounder R, Hamilton MR, Chronos NAF, Ball S, Mercieca JE, Olausson M, Cederberg C: Twenty-four hour intragastric acidity and plasma gastrin concentration in healthy subjects and patients with duodenal or gastric ulcer, or pernicious anaemia. Aliment Pharmacol Ther 1:225–237, 1987Google Scholar
  141. 141.
    Derodra JK, Howden CW, Burget DW, Hunt RH: Twenty-four-hour intragastric acidity and nocturnal gastric secretion in gastric ulcer patients—the effects of cimetidine. Aliment Pharmacol Ther 4:275–281, 1990Google Scholar
  142. 142.
    Dent J, Holloway RH, Toouli J, Dodds WJ: Mechanisms of lower oesophageal sphincter incompetence in patients with symptomatic gastroesophageal reflux. Gut 29:1020–1028, 1988Google Scholar
  143. 143.
    Gudmundsson K, Johnsson F, Joelsson B: The time pattern of gastroesophageal reflux. Scand J Gastroenterol 23:75–79, 1988Google Scholar
  144. 144.
    de Caestecker JS, Blackwell JN, Pryde A, Heading RC: Daytime gastro-oesophageal reflux is important in oesophagitis. Gut 28:519–526, 1987Google Scholar
  145. 145.
    Iascone D, DeMeester TR, Little AG, Skinner DB: Barrett's esophagus: Functional assessment, proposed pathogenesis and surgical therapy. Arch Surg 118:543–549, 1983Google Scholar
  146. 146.
    Miller LS, Vinayek R, Frucht H, Gardner JD, Jensen RT, Maton PN: Reflux esophagitis in patients with Zollinger-Ellison syndrome. Gastroenterology 98:341–346, 1990Google Scholar
  147. 147.
    Collen MJ, Lewis JH, Benjamin SB: Gastric acid hypersecretion in refractory gastroesophageal reflux disease. Gastroenterology 98:654–661, 1990Google Scholar
  148. 148.
    Boesby S: Relationship between gastro-oesophageal acid reflux, basal gastro-oesophageal sphincter pressure, and gastric acid secretion. Scand J Gastroenterol 12:547–551, 1977Google Scholar
  149. 149.
    Matikainen M: Gastric acid secretion, oesophageal acid reflux, and oesophagitis in patients with symptomatic gastro-oesophageal reflux. Scand J Gastroenterol 16:1043–1048, 1981Google Scholar
  150. 150.
    Hirschowitz BI: A critical analysis, with approprite controls of gastric acid and pepsin secretion in clinical esophagitis. Gastroenterology 105:1149–1158, 1991Google Scholar
  151. 151.
    Griffith JL, Cummings OW, Hirschowitz BI: Development of sustained achlorhydria in a patient with Zollinger-Ellison syndrome treated with omeprazole. Gastroenterology 101: 242–246, 1991Google Scholar
  152. 152.
    Johansson K-E, Ask P, Boeryd B, Fransson S-G, Tibbling L: Oesophagitis, signs of reflux, and gastric acid secretion in patients with symptoms of gastro-oesophageal reflux disease. Scand J Gastroenterol 21:837–847, 1986Google Scholar
  153. 153.
    Robertson DAF, Aldersley MA, Shepherd H, Lloyd RS, Smith CL: H2 antagonists in the treatment of reflux oesophagitis: Can physiological studies predict the response? Gut 28:946–949, 1987Google Scholar
  154. 154.
    Helm F: Esophageal acid clearance. J Clin Gastroenterol 8(suppl 1):5–11, 1986Google Scholar
  155. 155.
    Johnson DA, Winters C, Spurling TJ, Chobanian SJ, Cattau EL Jr: Esophageal acid sensitivity in Barrett's esophagus. J Clin Gastroenterol 9:23–27, 1987Google Scholar
  156. 156.
    Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A: Esophageal peristaltic dysfunction in peptic oesophagitis. Gastroenterology 91:897–904, 1986Google Scholar
  157. 157.
    Kahrilas PJ, Dodds WJ, Hogan WJ: Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology 94:73–80, 1988Google Scholar
  158. 158.
    Schoeman MN, Tippett M, Dent J, Holloway RH: Integrity and characteristics of secondary peristalsis in patients with non-obstructive dysphagia. Gastroenterology 100:A157, 1991Google Scholar
  159. 159.
    Shaker R, Dodds WJ, Helm JF, Kern MK, Hogan WJ: Regional esophageal distribution and clearance of refluxed gastric acid. Gastroenterology 101:355–359, 1991Google Scholar
  160. 160.
    Helm JF, Dodds WJ, Hogan WJ: Salivary response to esophageal acid in normal subjects and patients with reflux esophagitis. Gastroenterology 93:1393–1397, 1987Google Scholar
  161. 161.
    Schiffrin MJ, Warren AA: Some factors concerned in production of experimental ulceration of the gastrointestinal tract in cats. Am J Dig Dis 9:205–209, 1942Google Scholar
  162. 162.
    Goldberg HI, Dodds SWJ, Gee S: Role of acid and pepsin in acute experimental esophagitis. Gastroenterology 56:223–230, 1969Google Scholar
  163. 163.
    Hirschowitz BI: Is stricture formation in esophagitis due to high acid and pepsin secretion? Gastroenterology 98:A60, 1990Google Scholar
  164. 164.
    Wallace JL: Gastric resistance to acid: Is the ‘mucus bicarbonate barrier’ functionally redundant? Am J Physiol 256: G31-G38, 1989Google Scholar
  165. 165.
    Attwood SEA, DeMeester TR, Bremner CG, Barlow AP, Hinder RA: Alkaline gastroesophageal reflux. Implications in the development of complications of Barrett's columnar-lined lower esophagus. Surgery 106:764–770, 1989Google Scholar
  166. 166.
    Collins BJ, Crothers G, McFarland RJ, Love AHG: Bile acid concentrations in the gastric juice of patients with erosive oesophagitis. Gut 26:495–499, 1985Google Scholar
  167. 167.
    Gillen P, Keeling P, Byrne PJ, Healy M, O'Moore RR, Hennessy TP: Implication of duodenogastric reflux in the pathogenesis of Barrett's oesophagus. Br J Surg 75:540–543, 1988Google Scholar
  168. 168.
    Mittal RK, Reuben A, Whitney JO, McCallum RW: Do bile acids reflux into the esophagus? A study in normal subjects and patients with gastroesophageal reflux disease. Gastroenterology 92:371–375, 1987Google Scholar
  169. 169.
    Kaye MD, Showalter JP: Pyloric incompetence in patients with symptomatic gastroesophageal reflux. J Lab Clin Med 83:198–206, 1974Google Scholar
  170. 170.
    Gotley DC, Morgan AP, Cooper MJ: Bile acid concentrations in the refluxate of patients with reflux oesophagitis. Br J Surg 75:587–590, 1988Google Scholar
  171. 171.
    Wallmark B, Stewart HB, Rabon E, Saccomani G, Sachs G: The catalytic cycle of gastric (H++K+)-ATPase. J Biol Chem 255:5313–5319, 1980Google Scholar
  172. 172.
    Soll AH, Weinstein WM, Kurata J, McCarthy D: Nonsteroidal anti-inflammatory drugs and peptic ulcer disease. Ann Intern Med 114:307–319, 1991Google Scholar
  173. 173.
    Debas HT: Peripheral regulation of gastric acid secretion.In Physiology of the Gastrointestinal Tract, Vol 2, 2nd ed. Johnson LR (ed). New York, Raven Press, 1987, pp 931–946Google Scholar
  174. 174.
    Wallmark B: Mechanism of action of omeprazole. Scand J Gastroenterol 21(suppl 118):11–16, 1986Google Scholar
  175. 175.
    Etienne A, Fimmel CJ, Bron BA, Loizeau E, Blum AL: Evaluation of pirenzepine on gastric acidity in healthy volunteers using ambulatory 24-hour intragastric pH-monitoring. Gut 26:241–245, 1985Google Scholar
  176. 176.
    Black JW, Duncan WAM, Durant CJ, Ganellin CR, Parsons EM: Definition and antagonism of histamine H2-receptors. Nature 236:385–390, 1972Google Scholar
  177. 177.
    Jones DB, Howden CW, Burget DW Kerr GD, Hunt RH: Acid suppression in duodenal ulcer: A meta-analysis to define optimal dosing with antisecretory drugs. Gut 28:1120–1127, 1987Google Scholar
  178. 178.
    Merki HS, Witzel L, Harre K, Scheurle E, Neumann J, Röhmel J: Single dose treatment with H2 receptor antagonists: Is bedtime administration too late? Gut 28:451–454, 1987Google Scholar
  179. 179.
    Kempf M, Kaufmann D, Walt RP, Heim J, Mappes A, Röehmel J, Merki H: TV snacks are bad for H2 receptor-blockade. Gastroenterology 94:A222, 1988Google Scholar
  180. 180.
    Merki HS, Halter F, Wilder-Smith CH, Allemann P, Witzel L, Kempf M, Röehmel J, Walt RP: Effect of food on H2-receptor blockade in normal subjects and duodenal ulcer patients. Gut 31:148–150, 1990Google Scholar
  181. 181.
    Merki HS, Wilder-Smith CH, Walt RP, Halter F: The cephalic and gastric phases of gastric secretion during H2-antagonist treatment. Gastroenterology 101:599–606, 1991Google Scholar
  182. 182.
    Kapur B, Mills JG, Glenny H, Burland WL, Lunt M, Bardhan KD: Evaluation of large single night-time doses of cimetidine using continuous 24-hour ambulatory gastric pH monitoring. Gut 26:A559, 1985Google Scholar
  183. 183.
    Howden CW, Tsai HH, Reid JL: Twenty-four-hour intragastric acidity in duodenal ulcer patients during dosing with placebo, and 150 mg ranitidine twice or four times daily. Aliment Pharmacol Ther 3:253–258, 1989Google Scholar
  184. 184.
    Hannan A, Chesner I, Mann S, Walt R: Can H2-antagonists alone completely block food stimulated acidity? Eur J Gastroenterol Hepatol 3:533–537, 1991Google Scholar
  185. 185.
    Wilder-Smith CH, Merki HS: Is the time of dosing of a potent long-acting H2-receptor antagonist critical? Twenty four-hour pH measurements with SKF-94482. Scand J Gastroenterol 26:501–507, 1991Google Scholar
  186. 186.
    Chiverton SG, Burget DW, Hunt RH: Do H2-receptor antagonists have to be given at night? A study of the secretory profile of SKF 94482—a new H2-receptor antagonist which has a profound effect on daytime acidity. Gut 30:594–599, 1989Google Scholar
  187. 187.
    Lanzon-Miller S, Pounder RE, Hamilton MR, Ball S, Chronos NAF, Raymond F, Olausson M, Cederberg C: Twenty-four-hour intragastric acidity and plasma gastrin concentration before and during treatment with either ranitidine and omeprazole. Aliment Pharmacol Ther 1:239–251, 1987Google Scholar
  188. 188.
    Burget DW, Chiverton SG, Hunt RH: Is there an optimal degree of acid suppression for healing of duodenal ulcer? A model of the relationship between ulcer healing and acid suppression. Gastroenterology 99:345–351, 1990Google Scholar
  189. 189.
    Prichard PJ, Yeomans ND, Mihaly GW, Jones DB, Buckle PJ, Smallwood RA, Louis WJ: Omeprazole: A study of its inhibition of gastric pH and oral pharmacokinetics after morning or evening dosage. Gastroenterology 88:64–69, 1985Google Scholar
  190. 190.
    Chiverton SG, Burget DW, Salena BJ, Hunt RH: Does misoprostol given as a single large dose improve its antisecretory effect? Aliment Pharmacol Ther 3:403–407, 1989Google Scholar
  191. 191.
    Elwin CE: Gastric acid responses to antral application of some amino acids, peptides, and isolated fractions of a protein hydrolysate. Scand J Gastroenterol 9:239–247, 1974Google Scholar
  192. 192.
    Deprez PH, Ghosh P, Goodlad RA, Lacey SL, Millership S, Playford RJ, Lee CY, Calam J: Hypergastrinaemia: A new mechanism. Lancet 338:410–411, 1991Google Scholar
  193. 193.
    Walsh JH, Richardson CT, Fordtran JS: pH dependence of acid secretion and gastrin release in normal and ulcer subjects. J Clin Invest 55:462–468, 1975Google Scholar
  194. 194.
    Walsh JH: Gastrointestinal hormones.In Physiology of the Gastrointestinal Tract, 2nd ed. Johnson LR (ed). New York, Raven Press, 1987, pp 181–253Google Scholar
  195. 195.
    Kline MM, McCallum RW, Curry N, Sturdevant RAL: Effect to gastric alkalization on lower esophageal sphincter pressure and serum gastrin. Gastroenterology 68:1137–1139, 1975Google Scholar
  196. 196.
    Svensson SO, Emås S, Kaess H, Dörner M: Significance of antral pH for gastrin release by insulin hypoglycemia in duodenal ulcer patients. Surgery 86:707–713, 1979Google Scholar
  197. 197.
    Peters MN, Feldman M, Walsh JH, Richardson CT: Effect of gastric alkalinization on serum gastrin concentrations in humans. Gastroenterology 85:35–39, 1983Google Scholar
  198. 198.
    Lind T, Cederberg C, Idström J-P, Olbe L, Lundell L: 24-hour intragastric acidity and plasma gastrin during long-term treatment with omeprazole or ranitidine in patients with reflux esophagitis. Scand J Gastroenterol 26:620–626, 1991Google Scholar
  199. 199.
    Lundell L, Backman L, Ekström P, Enander L-K, Falkmer S, Fausa O, Grimelius L, Havu N, Lind T, Lönroth H, Sandmark S, Sandzén B, Unge P, Westin IH: Prevention of relapse of reflux esophagitis after endoscopic healing: The efficacy and safety of omeprazole compared with ranitidine. Scand J Gastroenterol 26:248–256, 1991Google Scholar
  200. 200.
    Lamberts R, Creutzfeldt W, Stockmann F, Jacubaschke U, Maas S, Brunner G: Long-term omeprazole treatment in man: Effects on gastric endocrine cell populations. Digestion 39:126–135, 1988Google Scholar
  201. 201.
    Klinkenberg-Knol EC, Jansen JBMJ, Lamers CBHW, Nelis F, Snel P, Meuwissen SGM: Use of omeprazole in the management of reflux oesophagitis resistant to H2-receptor antagonists. Scand J Gastroenterol 24(suppl 166):88–93, 1989Google Scholar
  202. 202.
    Brunner GHG, Lamberts R, Creutzfeldt W: Efficacy and safety of omeprazole in the long-term treatment of peptic ulcer and reflux oesophagitis resistant to ranitidine. Digestion 47(suppl 1):64–68, 1990Google Scholar
  203. 203.
    Creutzfeldt W, Lamberts R: Is hypergastrinaemia dangerous to man? Scand J Gastroenterol 26(suppl 180):179–191, 1991Google Scholar
  204. 204.
    Chrisholm JC: Ranitidine hydrochloride-induced hypergastrinemia. J Natl Med Assoc 77:303–304, 1985Google Scholar
  205. 205.
    Jansen JBMJ, Klinkenberg-Knol EC, Meuwissen SGM, de Bruijne JW, Festen HPM, Snel P, Lückers AEG, Biemond I, Lamers CBHW: Effect of long-term treatment with omeprazole on serum gastrin and serum group A and C pepsinogens in patients with reflux esophagitis. Gastroenterology 99:621–628, 1990Google Scholar
  206. 206.
    Shay SS, Eggli D, McDonald C, Johnson LF: Gastric emptying of solid food in patients with gastroesophageal reflux. Gastroenterology 92:459–465, 1987Google Scholar
  207. 207.
    Maddern GJ, Chatterton BE, Collins PJ, Horowitz M, Shearman DJC, Jamieson GG: Solid and liquid gastric emptying in patients with gastro-oesophageal reflux. Br J Surg 72:344–347, 1985Google Scholar
  208. 208.
    McCallum RW, Berkowitz DM, Lerner E: Gastric emptying in patients with gastroesophageal reflux. Gastroenterology 80:285–291, 1991Google Scholar
  209. 209.
    Little AG, DeMeester TR, Rezai-Zadeh K, Skinner DB: Abnormal gastric emptying in patients with gastroesophageal reflux. Surg Forum 28:347–348, 1977Google Scholar
  210. 210.
    Csendes A, Henriquez A: Gastric emptying in patients with reflux esophagitis or benign strictures of the esophagus secondary to reflux compared to controls. Scand J Gastroenterol 13:205–207, 1978Google Scholar
  211. 211.
    Clark CG: Medical complications of gastric surgery for peptic ulcer. Compr Ther 7:26–32, 1981Google Scholar
  212. 212.
    Pounder RE, Smith JTL: Drug-induced changes in plasma gastrin concentration. Gastroenterol Clin North Am 19:141–153, 1990Google Scholar
  213. 213.
    Allen A, Pearson JP, Blackburn A, Coan RM, Hutton DA, Mall AS: Pepsins and the mucus barrier in peptic ulcer disease. Scand J Gastroenterol 23(suppl 146):50–55, 1988Google Scholar
  214. 214.
    Goldberg HI: Role of acid and pepsin in acute experimental esophagitis. Gastroenterology 56:223–230, 1969Google Scholar
  215. 215.
    Piper DW, Fenton B: The absorption of pepsin. Am J Dig Dis 6:134–141, 1961Google Scholar
  216. 216.
    Berstad A: A modified haemoglobin substrate method for the estimation of pepsin in gastric juice. Scand J Gastroenterol 5:343–348, 1970Google Scholar
  217. 217.
    Berstad A: Inactivation of human gastric pepsin by duodenal juice. Scand J Gastroenterol 6:241–244, 1971Google Scholar
  218. 218.
    Wilder-Smith CH, Halter F, Ernst T, Gennoni M, Zeyen B, Varga L, Roehmel JJ, Merki HS: Loss of acid suppression during dosing with H2-receptor antagonists. Aliment Pharmacol Ther 4(suppl 1):15–27, 1990Google Scholar
  219. 219.
    Nwokolo CU, Smith JTL, Gavey C, Sawyerr A, Pounder RE: Tolerance during 29 days of conventional dosing with cimetidine, nizatidine, famotidine or ranitidine. Aliment Pharmacol Ther 4(suppl 1):29–45, 1990Google Scholar
  220. 220.
    Wilder-Smith CH, Ernst T, Gennoni M, Zeyen B, Halter F, Merki HS: Tolerance to oral H2-receptor antagonists. Dig Dis Sci 35:976–983, 1990Google Scholar
  221. 221.
    Misiewicz JJ: Clinical relevance of tolerance to peptic ulcer healing and relapse. Aliment Pharmacol Ther 4(suppl 1):85–96, 1990Google Scholar
  222. 222.
    Smith JTL, Gavey C, Nwokolo CU, Pounder RE: Tolerance during 8 days of high dose H2-blockade: Placebo-controlled studies of 24-hour acidity and gastrin. Aliment Pharmacol Ther 4(suppl 1):47–63, 1990Google Scholar
  223. 223.
    Rogers MJ, Holmfield JHM, Primrose JN, Johnston D: The effects of 15 days of dosing with placebo, sufotidine 600 mg nocte or 600 mg twice daily upon 24-hour intragastric acidity and 24-hour gastrin. Aliment Pharmacol Ther 4(suppl 1):65–74, 1990Google Scholar
  224. 224.
    Wilder-Smith CH, Halter F, Merki HS: Tolerance and rebound to H2-receptor antagonists: Intragastric acidity in patients with duodenal ulcer. Dig Dis Sci 36:1685–1690, 1991Google Scholar
  225. 225.
    Hyman PE, Garvey TQ III, Abrams CE: Tolerance to intravenous ranitidine. J Pediatr 110:794–796, 1987Google Scholar
  226. 226.
    Merki HS, Wilder-Smith CH, Walt RP, Hunt R, Renner EL, Halter F: Differential circadian effects and development of tolerance to an H2-receptor antagonist. Gastroenterology 98:A88, 1990Google Scholar
  227. 227.
    Wilder-Smith CH, Halter F, Merki HS: Gastric pH-control with i.v. H2-antagonists: Fixed-dose versus pH-feedback controlled ranitidine infusion in healthy volunteers. Gastroenterology 100:A185, 1991Google Scholar
  228. 228.
    Chiverton SG, Hunt RH: Initial therapy and relapse of duodenal ulcer: Possible acid secretory mechanisms. Gastroenterology 96:632–639, 1989Google Scholar
  229. 229.
    Fullarton GM, McLaughlan, G, MacDonald A, Crean GP, McColl KEL: Rebound nocturnal hypersecretion after four weeks treatment with an H2 antagonist. Gut 30:449–454, 1989Google Scholar
  230. 230.
    Marks IN, Johnston DA, Young GO: Acid secretory changes and early relapse following duodenal ulcer healing with sucralfate, ranitidine, antacids or omeprazole.In Mechanisms of Peptic Ulcer Healing. Halter F, Garner A, Tytgat CNJ (eds). Dordrecht, Kluwer, 1991, pp 273–282Google Scholar
  231. 231.
    Aadland E, Berstad A: Parietal and chief cell sensitivity to histamine and pentagastrin stimulation before and after cimetidine treatment in healthy subjects. Scand J Gastroenterol 14:933–938, 1979Google Scholar
  232. 232.
    Frislid K, Aadland E, Berstad A: Augmented postprandial gastric acid secretion due to exposure to ranitidine in healthy subjects. Scand J Gastroenterol 21:119–122, 1986Google Scholar
  233. 233.
    Nwokolo CU, Smith JTL, Pounder RE: Rebound intragastric hyperacidity occurs following dosing with cimetidine, nizatidine, and famotidine. Gastroenterology 96:A369, 1989Google Scholar
  234. 234.
    Fullarton GM, MacDonald AMI, McColl KEL: Rebound hypersecretion after H2-antagonist withdrawal—a comparative study with nizatidine, ranitidine, and famotidine. Aliment Pharmacol Ther 5:391–398, 1991Google Scholar
  235. 235.
    Prewett EJ, Hudson M, Nwokolo CU, Sawyer AFM, Pounder RE: Nocturnal intragastric acidity during and after a period of dosing with either ranitidine or omeprazole. Gastroenterology 100:873–877, 1991Google Scholar
  236. 236.
    Kummer AF, Johnston DA, Marks IN, Young GO, Tigler-Wybrandi NA, Bridger SA: Changes in nocturnal acid outputs after duodenal ulcer healing with ranitidine or sucralfate. Gut 33:175–179, 1992Google Scholar
  237. 237.
    Aadland E, Berstad A: Parietal and chief cell sensitivity to pentagastrin stimulation before and after cimetidine treatment for duodenal ulcer. Scand J Gastroenterol 14:111–114, 1979Google Scholar
  238. 238.
    Marks IN, Young GO, Tigler-Wybrandi NA, Bridger S, Newton KA: Acid-secretory response and parietal cell sensitivity in patients with duodenal ulcer before and after treatment with sucralfate or ranitidine. Am J Med 86(suppl 6A):145–147, 1989Google Scholar
  239. 239.
    Johnston DA, Marks IN, Young GO, Tigler-Wybrandi NA, Bridger S: Duodenal ulcer healing and acid secretory responses to modified sham feeding and pentagastrin stimulation. Aliment Pharmacol Ther 4:403–410, 1990Google Scholar
  240. 240.
    Savarino V, Mela GS, Zentilin P, Sumberaz A, Bonifacino G, Celle G: Lack of gastric acid rebound after stopping a successful short-term course of nizatidine in duodenal ulcer patients. Am J Gastroenterol 86:281–284, 1991Google Scholar
  241. 241.
    Walsh JH, Sytnik B, Maxwell V, Chew P, Karnes W, Lu S, Randall G, Reedy TJ, Root J, Lengeric R: Reversibility of plasma gastrin changes induced by omeprazole or ranitidine in man. Am J Gastroenterol 83:1042(A), 1988Google Scholar
  242. 242.
    Yokota H, Yanaka A, Muto H: Effect of H+K+-dependent ATPase inhibitor (omeprazole) on parietal cell sensitivity in duodenal ulcer patients. Gastroenterol Int 1(suppl 1):480A, 1988Google Scholar
  243. 243.
    Johnston DA, Marks IN, Young GO, Tigler-Wybrandi NA, Bridger S, Zak J: Acid secretory responses and parietal cell sensitivity following duodenal ulcer healing with omeprazole, sucralfate and Maalox. Am J Med 91:91S-94S, 1991Google Scholar
  244. 244.
    Fullarton GM, McLaughlan G, MacDonald A, Crean GP, McColl KEL: Rebound nocturnal hypersecretion after four weeks treatment with an H2 receptor antagonist. Gut 30:449–454, 1989Google Scholar
  245. 245.
    Jones DB, Howden CW, Burget DW, Silletti C, Hunt RH: Alteration of H2 receptor sensitivity in duodenal ulcer patients after maintenance treatment with an H2 receptor antagonist. Gut 29:890–893, 1988Google Scholar
  246. 246.
    Dobrilla G, Vallaperta P, Amplatz S: Influence of ulcer healing agents on relapse after discontinuation of acute treatment: A pooled estimate of controlled clinical trials. Gut 29:181–187, 1988Google Scholar
  247. 247.
    Marks IN, Young GO: Changes in acid secretory response and parietal cell sensitivity on healing predict early relapse in patients with duodenal ulcer. Am J Gastroenterol 83:1075, 1988 (abstract)Google Scholar
  248. 248.
    Yanaka A, Muto H: Increased parietal cell responsiveness to tetragastrin in patients with recurrent duodenal ulcer. Dig Dis Sci 33:1459–1465, 1988Google Scholar
  249. 249.
    Marks IN: Sucralfate: Efficacy and basis for therapy.In Ulcer Disease-Investigation and Basis for Therapy. Swabb EA, Szabo S (eds). New York, Marcel Decker, 1991 (Clinical Pharmacology Ser. No. 17)Google Scholar
  250. 250.
    Johnston DA, Marks IN: Relapse rates after duodenal ulcer healing-apples or pears? Gut 30:1299–1300, 1989Google Scholar
  251. 251.
    Jones DB, Howden CW, Burget DW, Kerr GD, Hunt RH: Acid suppression in duodenal ulcer: A meta-analysis to define optimal dosing with antisecretory drugs. Gut 28:1120–1127, 1987Google Scholar
  252. 252.
    Merki HS, Witzel L, Walt RP, Neumann J, Scheurle E, Mappes A, Krammisch H, Heim J, Kaufmann D, Röehmel J: Double blind comparison of the effects of cimetidine, ranitidine, famotidine and placebo on intragastric acidity in 30 normal volunteers. Gut 29:81–84, 1988Google Scholar
  253. 253.
    Hannan A, Chesner I, Merki HS, Mann S, Walt RP: Use of automatic computerised pump to maintain constant intragastric pH. Gut 31:1246–1249, 1990Google Scholar
  254. 254.
    Bianchi Porro G, Parente F: Long term treatment of duodenal ulcer. A review of management options. Drugs 41:38–51, 1991Google Scholar
  255. 255.
    Lauritsen K, Rune SJ, Bytzer P, Kelbaek H, Jensen KG, Rask-Madsen J, Bendtsen F, Linde J, Højlund M, Andersen HH, Møllmann K-M, Nissen VR, Oveson L, Schlichting P, Tage-Jansen U, Wulff H: Effect of omeprazole and cimetidine on duodenal ulcer. A double-blind comparative trial. N Engl J Med 312:958–961, 1985Google Scholar
  256. 256.
    Lane MR, Lee SP: Recurrence of duodenal ulcer after medical treatment. Lancet 1:1147–1149, 1988Google Scholar
  257. 257.
    Miller JP, Faragher EB: Relapse of duodenal ulcer: Does it matter which drug is used in initial treatment? Br Med J 293:1117–1118, 1986Google Scholar
  258. 258.
    Marshall BJ, Goodwin CS, Warren JR, Murray R, Blincow ED, Blackbourn SJ, Phillips M, Waters TE, Sanderson CR: Prospective double-blind trial of duodenal ulcer relapse after eradication ofCampylobacter pylori. Lancet 2:1437–1442, 1988Google Scholar
  259. 259.
    George LL, Borody TJ, Andrews P, Devine H, Moore-Jones D, Walton M, Brandl S: Cure of duodenal ulcer after eradication ofHelicobacter pylori. Med J Aust 153:145–149, 1990Google Scholar
  260. 260.
    Mégraud F, Bouchard S, Lamouliatte H: Proton pump inhibitors have an antimicrobial activity againstHelicobacter pylori. Gastroenterology 100:A123, 1991Google Scholar
  261. 261.
    Unge P, Gad A, Eriksson K, Bergman B, Carling L, Ekström P, Glise H, Gnarpe H, Junghard O, Loindholmer C, Sandzén B, Strandberg L, Stubberöd A, Weywardt L: Amoxicillin added to omeprazole prevents relapse in the treatment of duodenal ulcer patients. Eur J Gastroenterol Hepatol 5:325–331, 1993Google Scholar
  262. 262.
    Hunt RH: pH and Hp—gastric acid secretion andHelicobacter pylori: Implications for ulcer healing and eradication of the organism. Am J Gastroenterol 88:481–483, 1993Google Scholar
  263. 263.
    Johansen AA, Hansen OH: Heterotopic gastric epithelium in the duodenum and its correlation to gastric disease and acid level. Acta Pathol Microbiol Scand A81:676–680, 1973Google Scholar
  264. 264.
    Carrick J, Lee A, Hazell S, Ralston M, Daskalopoulos G:Campylobacter pylori, duodenal ulcer, and gastric metaplasia: possible role of functional heterotopic tissue in ulcerogenesis. Gut 30:790–797, 1989Google Scholar
  265. 265.
    Friess H, Buchler M, Malfertheiner P, Flock F, Baczako K, Stanescu A, Beger HG: Elimination ofHelicobacter pylori by single shot antibiotic treatment in patients undergoing vagotomy. Gastroenterology 100:A67, 1991Google Scholar
  266. 266.
    Wyatt JI, Rathbone BJ, Sobala GM, Shallcross T, Heatley RV, Axon AT, Dixon MF: Gastric epithelium in the duodenum: Its association withHelicobacter pylori and inflammation. J Clin Pathol 43:981–986, 1990Google Scholar
  267. 267.
    Schiller LR, Fordtran JS: Ulcer complications during short term therapy of duodenal ulcer with active agents and placebo. Gastroenterology 90:478–481, 1986Google Scholar
  268. 268.
    Wade AG, Rowley-Jones D: Long term management of duodenal ulcer in general practice: How best to use cimetidine? Br Med J 296:971–974, 1988Google Scholar
  269. 269.
    Boyd EJS, Wilson JA, Wormsley KG: Safety of ranitidine maintenance treatment for duodenal ulcer. Scand J Gastroenterol 19:394–400, 1984Google Scholar
  270. 270.
    Walan A, Bianchi-Porro G, Hentschel E, Bardhan KD, Delaterre M: Maintenance treatment with cimetidine in peptic ulcer disease for up to 4 years. Scand J Gastroenterol 22:397–405, 1987Google Scholar
  271. 271.
    Thorat VK, Misra SP, Anand BS: Conventional versus ondemand therapy for duodenal ulcer: Results of a controlled therapeutic trial. Am J Gastroenterol 85:243–248, 1990Google Scholar
  272. 272.
    Bardhan KD: Intermittent treatment of duodenal ulcer for long term medical management. Postgrad Med J 64(suppl 1):40–46, 1988Google Scholar
  273. 273.
    Freston JW: On-demand treatment for duodenal ulcers: Has its time come? Am J Gastroenterol 85:241–242, 1990Google Scholar
  274. 274.
    Witzel L, Ansari A, Blum AL, Merki H: Comparison of maintenance treatment versus intermittent treatment with ranitidine in preventing duodenal ulcers. Gastroenterology 98:A149, 1990Google Scholar
  275. 275.
    Howden CW, Hunt RH: The relationship between suppression of acidity and gastric ulcer healing rates. Aliment Pharmacol Ther 4:25–33, 1990Google Scholar
  276. 276.
    Howden CW, Burget DW, Hunt RH: A meta-analysis to predict gastric ulcer healing from acid suppression. Gastroenterology 100:A85, 1991Google Scholar
  277. 277.
    Holloway RH, Downton J, Mitchell B, Dent J: Effect of cisapride on postprandial gastro-oesophageal reflux. Gut 30:1187–1193, 1989Google Scholar
  278. 278.
    Shay SS, Eggli D, McDonald C, Johnson LF: Gastric emptying of solid food in patients with gastroesophageal reflux. Gastroenterology 92:459–465, 1987Google Scholar
  279. 279.
    Maddern GJ, Chatterton BE, Collins PJ, Horowitz M, Shearman DJ, Jamieson GG: Solid and liquid gastric emptying in patients with gastro-oesophageal reflux. Br J Surg 72:344–347, 1985Google Scholar
  280. 280.
    McCallum RW, Berkowitz DM, Lerner E: Gastric emptying in patients with gastroesophageal reflux. Gastroenterology 80:285–291, 1981Google Scholar
  281. 281.
    Koelz HR: Treatment of reflux esophagitis with H2-blockers, antacids, and prokinetic drugs. An analysis of randomized clinical trials. Scand J Gastroenterol 24(suppl 156):25–36, 1989Google Scholar
  282. 282.
    Shaker R, Kahrilas RA, Dodds WJ, Hogan WJ: Esophageal clearance of small amounts of acid. Gastroenterology 90:A1628, 1986Google Scholar
  283. 283.
    Bate CM, Keeling PWN, O'Morain C, Wilkinson SP, Foster DN, Mountford RA, Temperley JM, Harvey RF, Thompson DG, Davis M: Comparison of omeprazole and cimetidine in reflux oesophagitis: Symptomatic, endoscopic and histological evaluations. Gut 31:968–972, 1990Google Scholar
  284. 284.
    Dent J: Australian clinical trials of omeprazole in the management of reflux oesophagitis. Digestion 47(Suppl 1):69–71, 1990Google Scholar
  285. 285.
    Dent J, Klinkenberg-Knol EC, Elm G, Eriksson K, Rikner L, Sölvell L: Omeprazole in the long-term management of patients with reflux oesophagitis refractory to histamine H2-receptor antagonists. Scand J Gastroenterol 24(suppl 166):176, 1989Google Scholar
  286. 286.
    Lundell L, Backman L, Ekström P, Enander L-K, Falkmer S, Fanga O, Grimelius L, Havu N, Lind T, Lönroth H, Sandmark S, Sandzén P, Unge P, Westin I: Prevention of relapse of reflux oesophagitis after endoscopic healing: The efficacy and safety of omeprazole compared with ranitidine. Scand J Gastroenterol 26:248–256, 1991Google Scholar
  287. 287.
    Deviere J, Buset M, Dumorceau J-M, Rickaert F, Cremer M: Regression of Barrett's epithelium with omeprazole. N Engl J Med 320:1497–1498, 1989Google Scholar
  288. 288.
    Wilkinson SP, Gore S, Sutton R, Eyre-Brook IA, Gear MWL, Shepherd NA: Regression of columnar epithelium in Barrett's oesophagus with omeprazole. Gut 31:A1191-A1192, 1990Google Scholar
  289. 289.
    Gore S, Healey CJ, Sutton R, Shepherd NA, Wilkinson SP: Regression of columnar lined (Barrett's) oesophagus with continuous omeprazole therapy. Aliment Pharmacol Ther 7:623–628, 1993Google Scholar
  290. 290.
    Brand DL, Ylvisaker JT, Gelfand M, Pope CE II: Regression of columnar esophageal (Barrett's) epithelium after antireflux surgery. N Engl J Med 302:844–848, 1980Google Scholar
  291. 291.
    Skinner DB, Walther BC, Riddell RH, Schmidt H, Iascone C, DeMeester TR: Barrett's esophagus. Comparison of benign and malignant cases. Ann Surg 198:554–565, 1983Google Scholar
  292. 292.
    Goldsmith MF: Regression of Barrett's esophagus seen after surgical intervention. Arch Intern Med 144:1117, 1984Google Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Richard H. Hunt
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
  • Christer Cederberg
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
  • John Dent
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
  • Fred Halter
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
  • Colin Howden
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
  • I. N. Solly Marks
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
  • Simon Rune
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
  • Robert P. Walt
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
  1. 1.Division of GastroenterologyMcMaster University Medical CenterHamiltonCanada
  2. 2.Astra Hässle ABMölndalSweden
  3. 3.Gastroenterology UnitRoyal Adelaide HospitalAdelaideAustralia
  4. 4.Gastrointestinal Unit, InselspitalUniversity of BernBernSwitzerland
  5. 5.Division of Digestive Diseases and NutritionRichland Medical ParkColumbiaUSA
  6. 6.Gastro-Intestinal ClinicGroote Schuur Hospital ObservatorySouth Africa
  7. 7.Glostrup HospitalGlostrupDenmark
  8. 8.Queen Elizabeth HospitalBirminghamUK

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