Last update:
08-Jul-2004

Gastro-esophageal reflux disease (GERD) is a disease of high prevalence which presents with heartburn and/ or acid regurgitation. GERD may include patients with or without esophagitis or other organic complications. The management of GERD is currently based on the antisecretory agents which suppress gastric acid secretion resulting in both symptomatic relief and healing of possible lesions of the esophageal mucosa. GERD treatment includes proton pump inhibitors (PPIs) or, alternatively for mild cases, histamine type-2 receptor antagonists (H₂RAs). Even high dosage ΡΡΙs therapy cannot achieve complete suppression of acid secretion and is associated with acid breakthrough phenomena observed more frequently in bed. In particular, nocturnal gastric acid breaktrhough has been observed in about 3/4 of GERD patients under PPIs, with gastro-esophageal acid reflux developing in half of them. Various studies suggest that the addition of ranitidine, a H₂RA, before bedtime in patients receiving PPI twice daily is the only effective therapy, at least on a demand basis, for nocturnal acid breakthrough. In clinical practice, nocturnal acid breakthrough phenomena under PPIs are particularly important for patients with refractory symptoms or for those requiring greater degrees of acid suppression, such as patients with severe esophagitis, Barrett’s esophagus, or atypical extraesophageal GERD manifestations.

Key words: Acid breakthrough, Gastro-esophageal reflux, Gastro-esophageal reflux disease, Histamine type-2 receptor antagonist, Nocturnal acid breakthrough, Omeprazole, Proton pump inhibitor, Ranitidine.