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Volume 3, Supplement 4, 2003

Volume 3, Supplement 4, 2003

Table of Contents

Ambulatory Intragastric pH Monitoring: Clinical Laboratory to Clinical Practice
Intragastric pH monitoring has become an important tool, used in the clinical laboratory to assess pharmacodynamic profiles of antisecretory agents. The technique is standardized, reproducible, and reliable. We have been able to compare antisecretory agents head-to-head, develop an understanding of interindividual variability in pH control with proton pump inhibitors, evaluate the role of H. pylori and its effect on intragastric pH, and gain insight into the potential role of genetic variation in cytochrome p450 status and its effect on pH control. These laboratory experiences can be used in clinical practice to aid in management of patients with gastroesophageal reflux disease. [Rev Gastroenterol Disord. 2003;3(suppl 4):S3-S9]
Alternative Dosing for Proton Pump Inhibitor Therapy: Rationale and Options
The target goal for all acid suppressive therapy is to optimize control of intragastric pH over extended periods of time. A somewhat axiomatic paradigm has been that effective control of gastric acid production is associated with optimal outcome in acid-related diseases. The proton pump inhibitor (PPI) class of therapy has shown superiority for effective control of acid and healing of related diseases. Traditional delivery of PPIs may not be a viable option for all patients. Therefore, a clear understanding of alternative dosing formulations and related efficacies is key in order for the clinician to select the most appropriate agent and strategy to optimize outcomes and cost-effectiveness for each patient. [Rev Gastroenterol Disord. 2003;3(suppl 4):S10-S15]
Epigastric Pain in Dyspepsia and Reflux Disease
Epigastric pain may occur as a specific and localized symptom, as part of a group of symptoms that include heartburn, or in association with bloating or early satiety. The current classification (Rome II) characterizes ulcer-like dyspepsia by predominant pain centered in the upper abdomen and characterizes dysmotility-like dyspepsia by discomfort. The large number of patients presenting with epigastric pain has led to the development of empirical strategies. [Rev in Gastroenterol Disord. 2003;3(suppl 4):S16-S21]
Sleep Issues in Gastroesophageal Reflux Disease: Beyond Simple Heartburn Control
There is a burgeoning interest in the relationship between sleep-related gastroesophageal reflux (GER) and the development of esophageal and extra esophageal complications. The physiological changes associated with sleep, such as suspension of the regulation of body temperature, may influence nocturnal GER and esophageal acid clearance. Data indicate that sleep induces considerable risk of prolonged acid mucosal contact and facilitates the occurrence of proximal migration of acid, thereby increasing the probability of pulmonary aspiration. Nocturnal GER can lead to the development of esophagitis and other extra esophageal complications, such as exacerbation of asthmatic symptoms. [Rev Gastroenterol Disord. 2003;3(suppl 4):S22-S29]
The Role of Proton Pump Inhibitors in NSAID-Associated Gastropathy and Upper Gastrointestinal Symptoms
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely used drugs in the United States. Ulcers are found with an endoscopy in 15%- 30% of patients who are using NSAIDs regularly, and the annual incidence of upper gastrointestinal (GI) clinical events is 2.5%-4.5% among those who use NSAIDs regularly. Upper GI symptoms, such as dyspepsia, also occur in up to 60% of patients taking NSAIDs. H2-receptor antagonists when used at standard doses are not effective at preventing gastric ulcers resulting from the use of NSAIDs. Misoprostol effectively decreases NSAID-induced ulcers and GI complications, but issues of compliance (multiple daily doses) and side effects (eg, diarrhea and dyspepsia) may limit its use. Once-daily therapy with proton pump inhibitors has been documented to significantly decrease the development of NSAID-associated ulcers in endoscopic studies, reduce the rate of NSAID-related ulcer complications, and reduce upper GI symptoms in NSAID users. [Rev Gastroenterol Disord. 2003;3(suppl 4):S30-S39]