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  • Title: Night-time intra-oesophageal bile and acid: a comparison between gastro-oesophageal reflux disease patients who failed and those who were treated successfully with a proton pump inhibitor.
    Author: Hershcovici T, Jha LK, Cui H, Powers J, Fass R.
    Journal: Aliment Pharmacol Ther; 2011 Apr; 33(7):837-44. PubMed ID: 21261670.
    Abstract:
    BACKGROUND: Little is known about the contribution of bile and acid reflux to night-time symptoms generation in patients who failed PPI treatment. AIM: To compare the degree of night-time oesophageal acid and bile [by the surrogate duodenogastroesophageal reflux (DGER)] exposure between gastro-oesophageal reflux disease (GERD) patients who failed and those who fully responded to PPI once a day while on treatment. METHODS: Gastro-oesophageal reflux disease patients were assigned to the PPI failure group if they continued to report symptoms ≥3/week and to the PPI success group if they were asymptomatic for the last 3 months while on PPI once a day. All patients underwent upper endoscopy and subsequently simultaneous 24-h oesophageal Bilitec and pH testing while on PPI treatment. RESULTS: Twenty-three patients were enrolled into the PPI failure group and 24 patients into the PPI success group. The percentage of night-time pH<4 and the number of night-time acid reflux episodes were significantly higher in the PPI failure group as compared with the PPI success group. All night-time DGER parameters were similar between the PPI failure and PPI success groups. CONCLUSIONS: Night-time oesophageal acid exposure is significantly higher in the PPI failure group vs. PPI success group. The degree of night-time bile reflux is similar in the two groups of patients with GERD.
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