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Nocturnal acid breakthrough and esophageal acidification during treatment with dexlansoprazole as compared to omeprazole in patients with gastroesophageal reflux disease



Nocturnal acid breakthrough (NAB) may differ based on duration of proton pump inhibitor (PPI) action and Helicobacter pylori (H. pylori) infection; NAB may influence esophageal acidification (EA) and mucosal damage. Dexlansoprazole, a long-acting PPI, was not compared with omeprazole for NAB, gastric acid suppression, and EA in relation to H. pylori infection.


In this prospective open-label comparative observational study, gastroesophageal reflux disease (GERD) patients were evaluated using 24-h dual-channel pH-impedance monitoring while on dexlansoprazole (60 mg, n = 39) and omeprazole (20 mg, n = 41) to study the degree of gastric acid suppression, esophageal acid exposure, and NAB (primary outcome measures). H. pylori was detected by rapid urease test and histology.


NAB tended to be frequent with omeprazole than dexlansoprazole (33/41 [80.5%] vs. 23/39 [59%]; p = 0.06). Though nocturnal mean esophageal pH was comparable between the dexlansoprazole and omeprazole groups, its duration was less with the former (181.5 [15.2–334.2] vs. 283 [158–366] min, p = 0.03). NAB was as frequent in the H. pylori–infected than the non-infected group (11/19 [57.9%] vs. 45/61 [73.8%]; p = 0.1). The nocturnal gastric and esophageal pH in the H. pylori–infected group was higher than in the non-infected group (4.6 ± 1.7 vs. 4 ± 1.6, p = 0.157; 6.1 ± 0.6 vs. 5.8 ± 0.6, p = 0.128). Dexlansoprazole tended to increase 24-h and nocturnal mean gastric pH among H. pylori–infected more than omeprazole (5.9 ± 1.1 vs. 4.2 ± 1.7, p = 0.023; 5.7 ± 1.2 vs. 3.8 ± 1.5, p = 0.006).


Dexlansoprazole is more effective than omeprazole in suppressing gastric acid secretion, resulting in lesser EA and NAB, particularly in the presence of H. pylori.

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Authors and Affiliations



UCG, designed the study, recruited the study subjects, helped in performing 24-h pH-impedance monitoring, did data analysis, and wrote the first draft of the paper; AB, recruited the study subjects; AM, performed 24-h pH-impedance-metry; SR, helped in performing data analysis and manuscript writing. All the authors read approved the final version of the manuscript.

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Correspondence to Uday C. Ghoshal.

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UCG, AB, SR, and AM declare no conflict of  interest.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on

The study was reviewed and approved by SGPGIMS Institutional Ethics Committee (IEC Code 2017-39-IP-96).


The authors are solely responsible for the data and the paper’s contents. In no way are the honorary editor in chief, editorial board members, the Indian Society of Gastroenterology, or the printer/publishers responsible for this article’s results/findings and content.

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Ghoshal, U.C., Blaachandran, A., Rai, S. et al. Nocturnal acid breakthrough and esophageal acidification during treatment with dexlansoprazole as compared to omeprazole in patients with gastroesophageal reflux disease. Indian J Gastroenterol (2022).

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  • Ambulatory pH-metry,  Esophageal acid exposure
  • Gastric acid
  • Gastroesophageal reflux
  • Helicobacter pylori
  • Impedance monitoring, Proton pump inhibitor
  • Sleep disorders