PMID- 15097034
OWN - NLM
STAT- MEDLINE
DCOM- 20040723
LR  - 20190906
IS  - 0954-691X (Print)
IS  - 0954-691X (Linking)
VI  - 16
IP  - 5
DP  - 2004 May
TI  - Nocturnal acid breakthrough: pH, drugs and bugs.
PG  - 441-3
AB  - Nocturnal acid breakthrough (NAB) was defined by Peghini et al. in 1998 as the 
      presence of at least 60 continuous minutes of intragastric pH < 4 during the 
      overnight period (22:00-06:00 h) in patients taking a proton pump inhibitor (PPI) 
      twice-daily before meals. NAB was shown to occur in more than 70% of patients on 
      PPI therapy but can be decreased or eliminated by adding a histamine-2 receptor 
      antagonist (H2RA) at bedtime. Helicobacter pylori status influences intragastric 
      acid control on PPI therapy: H. pylori-positive patients having better gastric 
      acid control compared with their H. pylori-negative counterparts. Recent data 
      indicate that NAB might not occur in H. pylori-positive subjects on twice-daily 
      PPI, suggesting there is no need for combined PPI twice-daily and H2RA therapy to 
      control night-time gastric acid secretion in these individuals. The clinical 
      importance of NAB has been debated ever since this concept was introduced. The 
      importance of NAB in healthy subjects and asymptomatic, uncomplicated 
      gastro-oesophageal reflux disease patients on PPI therapy may be low, but 
      ignoring it in patients with poor oesophageal motility and Barrett's oesophagus 
      may result in suboptimal treatment. Further studies are warranted to investigate 
      whether leaving H. pylori to 'assist'acid suppression obtained by PPI 
      twice-daily, adding bedtime H2RAs after successful H. pylori eradication or other 
      approaches to eliminate NAB results in better clinical outcomes.
FAU - Tutuian, Radu
AU  - Tutuian R
AD  - Division of Gastroenterology-Hepatology, Medical University of South Carolina, 
      Charleston, South Carolina 29425, USA. tutuianr@musc.edu
FAU - Katz, Philip O
AU  - Katz PO
FAU - Castell, Donald O
AU  - Castell DO
LA  - eng
PT  - Journal Article
PL  - England
TA  - Eur J Gastroenterol Hepatol
JT  - European journal of gastroenterology & hepatology
JID - 9000874
RN  - 0 (Histamine H2 Antagonists)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Circadian Rhythm
MH  - Drug Administration Schedule
MH  - Drug Therapy, Combination
MH  - Gastric Acid/*metabolism
MH  - Gastric Acidity Determination
MH  - Gastroesophageal Reflux/*drug therapy/metabolism/microbiology
MH  - Helicobacter Infections/*drug therapy/metabolism
MH  - *Helicobacter pylori
MH  - Histamine H2 Antagonists/*administration & dosage/therapeutic use
MH  - Humans
MH  - Hydrogen-Ion Concentration
MH  - Middle Aged
MH  - *Proton Pump Inhibitors
EDAT- 2004/04/21 05:00
MHDA- 2004/07/24 05:00
CRDT- 2004/04/21 05:00
PHST- 2004/04/21 05:00 [pubmed]
PHST- 2004/07/24 05:00 [medline]
PHST- 2004/04/21 05:00 [entrez]
AID - 00042737-200405000-00001 [pii]
AID - 10.1097/00042737-200405000-00001 [doi]
PST - ppublish
SO  - Eur J Gastroenterol Hepatol. 2004 May;16(5):441-3. doi: 
      10.1097/00042737-200405000-00001.