Absence of nocturnal acid breakthrough in Helicobacter pylori-positive subjects treated with twice-daily omeprazole
Martinek, Jan; Pantoflickova, Drahoslava; Hucl, Tomas; Benes, Marek; Dorta, Gian; Lukas, Milan; Spicak, Julius
Background: Proton pump inhibitors (PPIs) taken twice daily do not effectively control night-time intragastric pH; nocturnal acid breakthrough (NAB) (arbitrarily defined as intragastric pH < 4 lasting longer than 1 h) occurs in more than 75% of patients.
The effectiveness of PPIs depends rather on the Helicobacter pylori status.
Objectives: To investigate the effectiveness of two regimens of omeprazole in H. pylori-positive subjects as well as the occurrence of NAB.
Patients: Fifteen otherwise healthy H. pylori-positive subjects participated in this randomized, crossover, double-blind study.
Methods: Night-time intragastric pH-metry was performed before (baseline) and on day 7 of two treatment courses with omeprazole (1 x 20 mg and 2 x 20 mg).
A 14-day (minimum) wash-out period was respected between the two treatment courses.
Results: Group medians (10-90% confidence intervals) for night-time intragastric pH (22:30-06:30 h) were as follows: baseline, 2 (1-6.1); 1 x 20 mg, 5 (3.3-6.9; P < 0.001 versus baseline); instead of, 2 x 20 mg, 6.3 (4.9-7.1; P < 0.001 versus baseline, P = 0.02 versus omeprazole 1 x 20 mg).
The percentage of time with intragastric pH < 3 was 65.4% during baseline (P < 0.05 versus both omeprazole regimens), 27% with once-daily omeprazole (P = 0.001 versus omeprazole 2 x 20 mg) and 0% with twice-daily omeprazole.
NAB occurred in eight (53.3%) subjects with once-daily omeprazole and in no subject taking twice-daily omeprazole.
Conclusions: In H. pylori-positive subjects, twice-daily omeprazole is highly effective in controlling nocturnal intragastric acidity.
NAB does not occur in those subjects and there is no need to add bedtime H2-receptor antagonists to this regimen.
(C) 2004 Lippincott Williams & Wilkins, Inc.
European Journal of Gastroenterology & Hepatology. 16(5):445-450, May 2004.
Absence of nocturnal acid breakthrough in Helicobacter pylori-positive subjects treated with twice-daily omeprazole.
Martinek, Jan a; Pantoflickova, Drahoslava b; Hucl, Tomas a; Benes, Marek a; Dorta, Gian b; Lukas, Milan c; Spicak, Julius a