Peghini P L, Katz P O, Castell D O
Department of Medicine Esophageal Laboratory, Graduate Hospital, Philadelphia, Pennsylvania, USA.
Gastroenterology. 1998 Dec;115(6):1335-9. doi: 10.1016/s0016-5085(98)70010-1.
BACKGROUND & AIMS: Proton pump inhibitors administered twice daily do not provide complete nocturnal acid suppression. Acid breakthrough, or decrease in intragastric pH to <4 for an hour or longer, occurs in three quarters of normal subjects and patients at night. We compared the effect of a third dose of omeprazole at bedtime with that of a dose of ranitidine at bedtime on residual nocturnal acid secretion in patients receiving omeprazole twice daily.
Twelve volunteers underwent overnight intragastric pH monitoring after 7 days of treatment with omeprazole, 20 mg twice daily, followed by different treatment supplements at bedtime: placebo; additional omeprazole, 20 mg; ranitidine, 150 mg; and ranitidine, 300 mg.
Additional omeprazole at bedtime reduced the percentage of time with intragastric pH of <4 from 48% to 31% (P < 0.005) compared with omeprazole twice daily with placebo at bedtime. Ranitidine at bedtime reduced this parameter more, 5% with 150 mg and 6% with 300 mg (P <0.01 vs. omeprazole twice daily plus bedtime). Results for percentage of time with intragastric pH <3 were similar. Eleven subjects had acid breakthrough with placebo at bedtime; 7 with omeprazole at bedtime (P = NS); 4 with ranitidine, 150 mg at bedtime; and 3 with ranitidine, 300 mg at bedtime (P < 0. 05, ranitidine vs. placebo).
Bedtime ranitidine is more effective than bedtime omeprazole on residual nocturnal acid secretion in patients receiving omeprazole twice daily. This finding suggests that fasting breakthrough nocturnal acid secretion in patients receiving omeprazole twice daily is most likely histamine related.
每日两次服用质子泵抑制剂不能完全抑制夜间胃酸分泌。在正常受试者和患者中，四分之三的人夜间会出现酸突破，即胃内pH值降至<4持续一小时或更长时间。我们比较了睡前服用第三剂奥美拉唑与睡前服用一剂雷尼替丁对每日两次服用奥美拉唑患者夜间残余胃酸分泌的影响。
12名志愿者在每日两次服用20mg奥美拉唑治疗7天后，进行夜间胃内pH值监测，随后在睡前给予不同的治疗补充剂：安慰剂；额外的20mg奥美拉唑；150mg雷尼替丁；300mg雷尼替丁。
与每日两次服用奥美拉唑并在睡前服用安慰剂相比，睡前额外服用奥美拉唑可使胃内pH值<4的时间百分比从48%降至31%（P<0.005）。睡前服用雷尼替丁的效果更佳，150mg雷尼替丁可使该参数降低5%，300mg雷尼替丁可使其降低6%（与每日两次服用奥美拉唑加睡前用药相比，P<0.01）。胃内pH值<3的时间百分比结果相似。11名受试者在睡前服用安慰剂时出现酸突破；7名在睡前服用奥美拉唑时出现酸突破（P=无统计学差异）；4名在睡前服用150mg雷尼替丁时出现酸突破；3名在睡前服用300mg雷尼替丁时出现酸突破（雷尼替丁与安慰剂相比，P<0.05）。
对于每日两次服用奥美拉唑的患者，睡前服用雷尼替丁在抑制夜间残余胃酸分泌方面比睡前服用奥美拉唑更有效。这一发现表明，每日两次服用奥美拉唑的患者夜间空腹时的突破性胃酸分泌很可能与组胺有关。
