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

Aliment Pharmacol Ther 2011; 33: 837–844

Summary

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.