Effect of H. pylori status on intragastric pH during treatment with omeprazole

Division of Gastroenterology, CHUV, Lausanne, Switzerland.
Gut (Impact Factor: 14.66). 05/1995; 36(4):539-43. DOI: 10.1136/gut.36.4.539
Source: PubMed


To test the hypothesis that Helicobacter pylori infection is associated with a decreased intragastric acidity during omeprazole therapy, ambulatory 24 hour dual point gastric pH recordings were performed in 18 H pylori positive and 14 H pylori negative subjects. There was a four to six week washout period between the two pH recordings made in each subject after one week courses of placebo or omeprazole, 20 mg daily. During placebo, median 24 hour pH values were not different in the corpus (H pylori positive = 1.5, negative = 1.4; p = 0.9) or antrum (H pylori positive = 1.3, negative = 1.2; p = 0.1). However, during omeprazole treatment, median 24 hour pH values were higher in H pylori positive subjects, both in the corpus (H pylori positive = 5.5, negative = 4.0; p = 0.001) and antrum (H pylori positive = 5.5, negative = 3.5; p = 0.0004). During placebo treatment, the only difference between the two groups was a higher later nocturnal pH in the antrum in the H pylori positive group. During omeprazole treatment, gastric pH was higher both in the corpus and in the antrum in the H pylori positive group for all periods, except for mealtime in the corpus. These data indicate that omeprazole produces a greater decrease in gastric acidity in subjects with H pylori infection than in those who are H pylori negative. It is not, however, known whether there is a causal relationship between H pylori infection and increased omeprazole efficacy.

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    • "In this trial no follow-up endoscopic evaluation was performed and, thus, no data on healing rates could be calculated (Scholten et al 2003). Helicobacter pylori infection has been shown to elevate the intragastric pH achieved by PPIs (Verdu et al 1995; Labenz et al 1996). In a study with pantoprazole, it has also been proposed that this increased effi cacy of PPIs in "
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    • "H. pylori colonization may to some extent protect against GERD and complications of GERD such as Barrett's oesophagus and oesophageal adenocarcinoma (O'Connor 1999). In addition, H. pylori gastritis may augment the acidsuppressive effects of proton pump inhibitors (Verdú et al. 1995). These two factors raised the concern that H. pylori eradication in patients with GERD may worsen reflux and impair symptom control by proton pump inhibitor therapy. "
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    • "Epidemiological studies demonstrate H. pylori-positive individuals have a lower gastroesophageal reflux disease prevalence (Sonnenberg & El-Serag 1999). Numerous studies demonstrate that proton pump inhibitor treatment has a greater acid suppressive effect in the H. pylori-positive than H. pylori-negative patients (Verdu et al. 1995a & b). Furthermore, studies have reported better control of symptoms and/or enhanced healing of mucosal lesions in patients infected with H. pylori with gastroesophageal reflux disease treated with proton pump inhibitors than in H. pylori-negative patients (Hatlebakk et al. 1999; Holtmann et al. 1999; Wu et al. 2004). "
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