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Basal acid output and gastric acid hypersecretion in gastroesophageal reflux disease

Correlation with ranitidine therapy

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Abstract

The purpose of this study was to evaluate possible differences in basal gastric acid secretion with regard to severity of gastroesophageal reflux disease. Basal acid output was determined by nasogastric suction in 228 patients with gastroesophageal reflux disease who received upper gastrointestinal endoscopy and were diagnosed with either pyrosis alone (N = 98), erosive esophagitis with or without pyrosis (N = 87), or Barrett's esophagus (N = 43). Mean basal acid output for the 228 patients with gastroesophageal reflux disease was 6.5 ± 5.6 meq/hr, which was significantly different from 65 normal subjects with a mean basal acid output of 3.0 ± 2.7 meq/hr (P < 0.0001). Compared to normal subjects, mean basal acid outputs significantly differed for patients with pyrosis (P < 0.05), esophagitis (P < 0.01), and Barrett's esophagus (P < 0.01). There was also a significant difference in mean basal acid output between the patients with pyrosis and Barrett's esophagus (P < 0.01). Nineteen of the 98 patients with pyrosis (19%), 24 of the 87 patients with esophagitis (28%), and 15 of the 43 patients with Barrett's esophagus (35%) had gastric acid hypersecretion (basal acid output greater than 10.0 meq/hr). One hundred forty-six patients with gastroesophageal reflux disease were treated with ranitidine in doses that resulted in complete healing of esophagitis and disappearance of pyrosis. Ninety-three patients responded to ranitidine 300 mg/day; however, 53 patients required increased dose of ranitidine (mean 1205 mg/day, range 600–3000 mg/day). There was a significant correlation between basal acid output and daily ranitidine dose required for therapy for the 146 patients with gastroesophageal reflux disease (r = 0.53,P = 0.0001). Furthermore, a significant association was also found between the presence of gastric acid hypersecretion and the requirement for increased doses of ranitidine (greater than 300 mg/day) (P = 0.00001). These results indicate that there is a subset of patients with gastroesophageal reflux disease who do have idiopathic gastric acid hypersecretion. Moreover, these patients have an apparently higher requirement for medication dosage in order to achieve therapeutic efficacy.

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Authors and Affiliations

  1. From the Divisions of Gastroenterology, Departments of Medicine, Loma Linda University Medical Center, Loma Linda, California

    Martin J. Collen MD, David A. Johnson MD & Michael J. Sheridan ScD

  2. Eastern Virginia School of Medicine, Norfolk, Virginia

    Martin J. Collen MD, David A. Johnson MD & Michael J. Sheridan ScD

  3. Institute of Medical Research, INOVA Health Systems, Falls Church, Virginia

    Martin J. Collen MD, David A. Johnson MD & Michael J. Sheridan ScD

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  2. David A. Johnson MD
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  3. Michael J. Sheridan ScD
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Collen, M.J., Johnson, D.A. & Sheridan, M.J. Basal acid output and gastric acid hypersecretion in gastroesophageal reflux disease. Digest Dis Sci 39, 410–417 (1994). https://doi.org/10.1007/BF02090216

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  • DOI: https://doi.org/10.1007/BF02090216

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