Drugs make stomach reflux less acidic

NEW YORK (Reuters Health) - Drugs such as Nexium and Prilosec, referred to as proton pump inhibitors, are effective treatments for gastroesophageal reflux. But when these drugs fail to bring relief, persistent heartburn may be the result of an increase in non-acidic reflux, researchers suggest in the journal Chest.

Gastroesophageal reflux disease, or (GERD), occurs when fluid in the stomach, which is highly acidic, moves into the esophagus, typically causing heartburn. Because of the change in body position, reflux is often worse during sleep. Persistent reflux can cause permanent changes in the lining of the esophagus, which can lead to cancer. The condition is commonly treated with medications, although surgery is sometimes required for patients who do not respond.

Dr. Suanne Goodrich and her associates at the Lynn Health Science Institute in Oklahoma City point out that the role of non-acid reflux during sleep has not been evaluated. They theorized that non-acidic reflux during sleep could cause prolonged esophageal exposure to bile salts and pancreatic enzymes, and increase the risk of inhalation of the reflux fluid.

In the current study, 15 subjects with heartburn were randomly assigned to treatment with Nexium (esomeprazole) or to inactive "placebo" for 1 week.

After the week of treatment, the subjects spent a night in the researchers' lab, where they underwent various reflux tests. Prior to going to bed, the subjects ate pizza, brownies and grape juice to increase the likelihood of reflux.

Treatment with Nexium reduced the rate of reflux episodes by approximately half, but the number of non-acid reflux events rose from 6 to 27.

The team notes that reflux may cause arousal during sleep, 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 nonacid reflux" indicates no increased risk of damage to the esophagus. On the other hand, Goodrich and her associates point out, the increase in episodes of non-acidic reflux may explain why some patients don't respond to drug treatment with proton pump inhibitors.

SOURCE: Chest, February 2007.