Appropriate acid suppression for the management of gastro-oesophageal reflux disease

N. J.V. Bell, D. Burget, Colin Howden, J. Wilkinson, R. H. Hunt

Research output: Contribution to journalArticle

492 Citations (Scopus)

Abstract

Gastro-oesophageal reflux disease (GORD) results from an abnormally prolonged dwell time of acidic gastric contents in the oesophagus. Although GORD is primarily a motor disorder, the injurious effects of gastric acid are central to the pathogenic process of oesophagitis, and the severity of disease correlates with the degree and duration of oesophageal acid exposure. In the majority of patients with mild disease, oesophageal acid exposure occurs predominantly during post-prandial periods. Conventional doses of H2-receptor antagonists cannot overcome the integrated stimulus to acid secretion resulting from a meal, and are thus relatively ineffective in preventing daytime, post-prandial oesophageal acid exposure. In patients with more severe grades of oesophagitis, there are abnormally high levels of nocturnal acid exposure, with the intra-oesophageal pH being less than 4.0 for 36% of the time, compared with 5% of the time in patients with mild GORD. Control of nocturnal acid secretion thus becomes increasingly important. This may be made worse by relative gastric acid hypersecretion in some patients with severe GORD. The long duration of action and effective inhibition of meal-stimulated acid secretion probably explains the superiority of omeprazole in treating GORD. Preliminary meta-analysis shows that the healing rate of cro sive oesophagitis at 8 weeks by antisecretory agents is directly related to the duration of suppression of gastric acid secretion achieved over a 24-hour period (r=0.87: p<0.05).

Original languageEnglish (US)
Pages (from-to)59-67
Number of pages9
JournalDigestion
Volume51
Issue numberSUPPL. 1
DOIs
StatePublished - Jan 1 1992
Externally publishedYes

Fingerprint

Esophageal Diseases
Gastroesophageal Reflux
Acids
Meals
Esophagitis
Gastric Acid
Histamine H2 Receptors
Gastrointestinal Contents
Omeprazole
Esophagus
Meta-Analysis

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Appropriate acid suppression for the management of gastro-oesophageal reflux disease. / Bell, N. J.V.; Burget, D.; Howden, Colin; Wilkinson, J.; Hunt, R. H.

In: Digestion, Vol. 51, No. SUPPL. 1, 01.01.1992, p. 59-67.

Research output: Contribution to journalArticle

Bell, NJV, Burget, D, Howden, C, Wilkinson, J & Hunt, RH 1992, 'Appropriate acid suppression for the management of gastro-oesophageal reflux disease', Digestion, vol. 51, no. SUPPL. 1, pp. 59-67. https://doi.org/10.1159/000200917
Bell, N. J.V. ; Burget, D. ; Howden, Colin ; Wilkinson, J. ; Hunt, R. H. / Appropriate acid suppression for the management of gastro-oesophageal reflux disease. In: Digestion. 1992 ; Vol. 51, No. SUPPL. 1. pp. 59-67.
@article{695d2ef06da04a1e9e74252660094667,
title = "Appropriate acid suppression for the management of gastro-oesophageal reflux disease",
abstract = "Gastro-oesophageal reflux disease (GORD) results from an abnormally prolonged dwell time of acidic gastric contents in the oesophagus. Although GORD is primarily a motor disorder, the injurious effects of gastric acid are central to the pathogenic process of oesophagitis, and the severity of disease correlates with the degree and duration of oesophageal acid exposure. In the majority of patients with mild disease, oesophageal acid exposure occurs predominantly during post-prandial periods. Conventional doses of H2-receptor antagonists cannot overcome the integrated stimulus to acid secretion resulting from a meal, and are thus relatively ineffective in preventing daytime, post-prandial oesophageal acid exposure. In patients with more severe grades of oesophagitis, there are abnormally high levels of nocturnal acid exposure, with the intra-oesophageal pH being less than 4.0 for 36{\%} of the time, compared with 5{\%} of the time in patients with mild GORD. Control of nocturnal acid secretion thus becomes increasingly important. This may be made worse by relative gastric acid hypersecretion in some patients with severe GORD. The long duration of action and effective inhibition of meal-stimulated acid secretion probably explains the superiority of omeprazole in treating GORD. Preliminary meta-analysis shows that the healing rate of cro sive oesophagitis at 8 weeks by antisecretory agents is directly related to the duration of suppression of gastric acid secretion achieved over a 24-hour period (r=0.87: p<0.05).",
author = "Bell, {N. J.V.} and D. Burget and Colin Howden and J. Wilkinson and Hunt, {R. H.}",
year = "1992",
month = "1",
day = "1",
doi = "10.1159/000200917",
language = "English (US)",
volume = "51",
pages = "59--67",
journal = "Digestion",
issn = "0012-2823",
publisher = "S. Karger AG",
number = "SUPPL. 1",

}

TY - JOUR

T1 - Appropriate acid suppression for the management of gastro-oesophageal reflux disease

AU - Bell, N. J.V.

AU - Burget, D.

AU - Howden, Colin

AU - Wilkinson, J.

AU - Hunt, R. H.

PY - 1992/1/1

Y1 - 1992/1/1

N2 - Gastro-oesophageal reflux disease (GORD) results from an abnormally prolonged dwell time of acidic gastric contents in the oesophagus. Although GORD is primarily a motor disorder, the injurious effects of gastric acid are central to the pathogenic process of oesophagitis, and the severity of disease correlates with the degree and duration of oesophageal acid exposure. In the majority of patients with mild disease, oesophageal acid exposure occurs predominantly during post-prandial periods. Conventional doses of H2-receptor antagonists cannot overcome the integrated stimulus to acid secretion resulting from a meal, and are thus relatively ineffective in preventing daytime, post-prandial oesophageal acid exposure. In patients with more severe grades of oesophagitis, there are abnormally high levels of nocturnal acid exposure, with the intra-oesophageal pH being less than 4.0 for 36% of the time, compared with 5% of the time in patients with mild GORD. Control of nocturnal acid secretion thus becomes increasingly important. This may be made worse by relative gastric acid hypersecretion in some patients with severe GORD. The long duration of action and effective inhibition of meal-stimulated acid secretion probably explains the superiority of omeprazole in treating GORD. Preliminary meta-analysis shows that the healing rate of cro sive oesophagitis at 8 weeks by antisecretory agents is directly related to the duration of suppression of gastric acid secretion achieved over a 24-hour period (r=0.87: p<0.05).

AB - Gastro-oesophageal reflux disease (GORD) results from an abnormally prolonged dwell time of acidic gastric contents in the oesophagus. Although GORD is primarily a motor disorder, the injurious effects of gastric acid are central to the pathogenic process of oesophagitis, and the severity of disease correlates with the degree and duration of oesophageal acid exposure. In the majority of patients with mild disease, oesophageal acid exposure occurs predominantly during post-prandial periods. Conventional doses of H2-receptor antagonists cannot overcome the integrated stimulus to acid secretion resulting from a meal, and are thus relatively ineffective in preventing daytime, post-prandial oesophageal acid exposure. In patients with more severe grades of oesophagitis, there are abnormally high levels of nocturnal acid exposure, with the intra-oesophageal pH being less than 4.0 for 36% of the time, compared with 5% of the time in patients with mild GORD. Control of nocturnal acid secretion thus becomes increasingly important. This may be made worse by relative gastric acid hypersecretion in some patients with severe GORD. The long duration of action and effective inhibition of meal-stimulated acid secretion probably explains the superiority of omeprazole in treating GORD. Preliminary meta-analysis shows that the healing rate of cro sive oesophagitis at 8 weeks by antisecretory agents is directly related to the duration of suppression of gastric acid secretion achieved over a 24-hour period (r=0.87: p<0.05).

UR - http://www.scopus.com/inward/record.url?scp=0026803020&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026803020&partnerID=8YFLogxK

U2 - 10.1159/000200917

DO - 10.1159/000200917

M3 - Article

VL - 51

SP - 59

EP - 67

JO - Digestion

JF - Digestion

SN - 0012-2823

IS - SUPPL. 1

ER -