NEW YORK (Reuters Health) Feb 12: Continuing heartburn symptoms even with proton pump inhibitor treatment for GERD may be explained my a relative increase in non-acidic reflux events, researchers in Oklahoma suggest in the February issue of Chest.
Dr. Suanne Goodrich and her associates at the Lynn Health Science Institute in Oklahoma City point out that onon-acid reflux during sleep has not been evaluted. They theorize that non-acid reflux during sleep could cause prolonged mucosal exposure to bile salts and pancreatic enzymes, and increase the risk of pulmonary aspiration.
In a crossover trial, 15 subjects with heartburn were assigned to treatment with 40mg Nexium for one week and to placebo for one week, in random order.
After a week of treatment, the subjects spent a night in the researchers' lab, where they under-went multichannel intraluminal impedance and PH monitoring during sleep. Prior to going to bed, the subjectss ate pizza, brownies, and grape juice to increase the likelihood of reflux.
Treatment with Nexium reduced the rate of reflux episodes by approximately half (73 to 39 per night), but the number of non-acid reflux events rose from 6 to 27.
The team notes that reflux may cause arousal, which actually protects the esophagus by increasing salivation and swallowing. They observed that most reflux events, either acidic or non-acidic, resulted in an arousal response within 2 minutes.
The fact that "the esophagus is equally responsive to acidic and non-acidic" indicates no increased risk of damage to the esophagus. On the other hand, Dr. Goodrich and her associates maintain, "the relative increase in non-acidic reflux events may explain the per-
sistence of symptoms in some patients treated with proton pump inhibitors."
I found this interesting for all of us who seem to think that the PPI's aren't working some of the time.....Sillylilly