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GERD Subjects with Increased Nocturnal Esophageal Acidity Have Increased Nocturnal Gastric Acidity

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Gardner, Jerry D., M.D.; Sloan, Sheldon, M.D.; Robinson, Malcolm, M.D.; Miner, Phillip B. Jr., M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S24
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Science for Organizations, Inc., Chatham, NJ; Janssen Pharmaceutica, Titusville, NJ and Oklahoma Foundation for Digestive Research, Oklahoma City, OK.

Purpose: Most normal subjects have most of their esophageal acid exposure during the daytime. GERD subjects, however, can be stratified on the basis of whether they have most of their esophageal acid exposure during daytime or nighttime.

Aim: To compare GERD subjects with predominately daytime esophageal reflux to those with predominately nighttime esophageal reflux with respect to esophageal and gastric acidity during an entire 24-hour period as well as during the daytime and nighttime periods.

Methods: Analyses were based on 24-hour recordings of esophageal and gastric pH from 59 subjects with GERD who experienced heartburn at least 4 times/week for at least 6 months. Daytime was 8:00–22:00 and nighttime was 22:00–8:00.

Results: Of the 59 GERD subjects, 34 had most of their esophageal acid exposure during daytime (daytime refluxers), and 25 had most of their acid exposure during nighttime (nighttime refluxers). Integrated esophageal acidity during the entire 24-hour period was significantly higher (P = .0023) in nighttime refluxers (22.6 [13.5, 67.4] mmol.hr/L; median [interquartile range]) than in daytime refluxers (13.5 [5.4, 16.4] mmol.hr/L). This increase could be accounted for by significantly higher (P < 0.0001) nighttime esophageal acidity in nighttime refluxers (15.6 [8.6, 52.5] mmol.hr/L) than in daytime refluxers (1.6 [0.3, 4.8] mmol.hr/L). Daytime esophageal acidity did not differ significantly between the two groups (P = 0.597). Similarly, integrated gastric acidity during the entire 24-hour period was significantly higher (P = 0.048) in nighttime refluxers (2079 [1739, 2351] mmol.hr/L) than in daytime refluxers (1711 [1357, 2046] mmol.hr/L). This increase could be accounted for by significantly higher (P = 0.021) nighttime gastric acidity in nighttime refluxers (1456 [1316, 1737] mmol.hr/L) than in daytime refluxers (1165 [853, 1483] mmol.hr/L). Daytime gastric acidity did not differ significantly between the two groups (P = 0.777).

Conclusions: GERD subjects with predominately nighttime esophageal reflux have higher 24-hour and nocturnal esophageal acidity than GERD subjects with predominantly daytime esophageal reflux, and these higher values for esophageal acidity can be accounted for by higher nocturnal gastric acidity.

© The American College of Gastroenterology 2005. All Rights Reserved.