gastrins and Heartburn

Topics: Antacids; Biopsy; Esophagitis, Peptic; Esophagogastric Junction; Esophagoscopy; Gastrins; Heartburn; Humans; Hydrochloric Acid; Manometry; Methacholine Compounds; Metoclopramide; Muscle, Smooth; Vagus Nerve

Topics: Cineradiography; Deglutition Disorders; Esophageal Achalasia; Esophageal Diseases; Esophageal Stenosis; Esophagogastric Junction; Esophagoscopy; Gastrins; Gastroesophageal Reflux; Heartburn; Hernia, Diaphragmatic; Humans; Manometry

Rebound acid hypersecretion after withdrawal of proton pump inhibitor (PPI) may lead to symptom aggravation and difficulties in withdrawing anti-reflux medication. The aim was to investigate pathophysiological and clinical consequences of on-demand treatment with PPI in patients with endoscopy-negative reflux disease.. Twenty-six patients with endoscopy-negative reflux disease were investigated for rebound effects of lansoprazole 15 mg, used on-demand, maximum 4 capsules daily during a 6-month period. P-CgA and s-gastrin were measured before, at termination and 2 weeks after stopping treatment. Symptom score was performed the week before and the second week after treatment, 24-h pH-metry after both periods.. Median daily consumption of lansoprazole was 15.1 mg (95% CI: 10.5; 18.8). S-gastrin before treatment was 31.2 pmol/l, 54.8 at the end (p < 0.01), 31.7 two weeks after withdrawal. P-CgA was 16.7 u/l before treatment, 37.5 at the end (p < 0.01), 17.7 two weeks after withdrawal (p = 0.35). A positive correlation was found between total consumption of lansoprazole and CgA increase during treatment (r = 0.44 p = 0.03). There was a reduction in symptom score during the treatment period from 30 (24-38) before, to 20 (15-36) the second week after treatment, p = 0.06. 32% had increase in symptoms.. Rebound acid hypersecretion is probably an infrequent problem in on-demand treatment with PPI in patients with endoscopy-negative reflux disease. A significant increase in p-CgA and s-gastrin was found after 6 months treatment. Fourteen days after withdrawal, CgA and gastrin returned to pretreatment levels. Overall, no aggravation of symptoms was found, but 1/3 experienced increased symptoms.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Aged; Anti-Ulcer Agents; Chromogranins; Esophagitis; Female; Gastric Acid; Gastrins; Heartburn; Humans; Lansoprazole; Laryngopharyngeal Reflux; Male; Middle Aged; Prospective Studies; Proton Pump Inhibitors; Secretory Rate

Gastroesophageal reflux disease (GERD) impairs the patient's quality of life (QOL), but the effect of long-term maintenance therapy in elderly patients is unknown.. We conducted a long-term prospective study. Forty-four GERD patients (11 males; mean age 74 years; QUEST score of at least 6 points) were enrolled in this study. Step-down therapy was selected (proton-pump inhibitor [PPI], histamine-2 receptor antagonist and prokinetic agents for 1 month, respectively). Optimal medication for each patient was continued for 5 years. The efficacy, safety of treatment and reflux symptoms were analyzed. The profiles of the patients who had to continue PPI maintenance therapy were also analyzed.. Reflux symptoms were reduced by the PPI based step-down therapy (baseline 13.8 times/month, after 3.2 times/month, P < 0.001). Reflux symptoms improved in 34 patients (77%). None of the 44 patients had to cease treatment because of side-effects and none experienced any complications during the 5-year period. The prevalence of Helicobacter pylori (Hp) infection in the PPI group (29%, 4/14) was significantly lower (P < 0.01) than in the other treatment group (72%, 21/29). The serum pepsinogen I/II ratio in the PPI treatment group (5.7 +/- 0.5) was significantly higher (P < 0.01) than in the others (4.0 +/- 0.3). The predictive factors for PPI maintenance therapy were Hp-negative status and serum pepsinogen I/II ratio >6.0 (odds ratio 12.0, 95% confidence interval 2.7-54.2).. Long-term medication for GERD selected on the basis of the patient's profile (i.e. Hp status and gastric atrophy) improved reflux symptoms.

Topics: Aged; Atrophy; Community Health Services; Drug Administration Schedule; Drug Therapy, Combination; Enzyme Inhibitors; Female; Follow-Up Studies; Gastric Emptying; Gastric Mucosa; Gastrins; Gastroesophageal Reflux; Gastrointestinal Agents; Heartburn; Helicobacter pylori; Histamine H2 Antagonists; Humans; Japan; Long-Term Care; Male; Pepsinogen A; Pepsinogen C; Prospective Studies; Proton Pump Inhibitors; Proton Pumps; Quality of Life; Time Factors; Treatment Outcome

The objective of this study was to compare the efficacy and safety of the proton pump inhibitor rabeprazole to that of the histamine-2 (H2)-receptor antagonist ranitidine in the treatment of erosive gastroesophageal reflux disease. The primary indicator of efficacy was the absence of esophageal erosions or ulcerations as determined by posttreatment endoscopy. Secondary indicators of efficacy included improvement in frequency and severity of daytime and nighttime heartburn.. A total of 338 patients were enrolled and randomly assigned to therapy with rabeprazole 20 mg once daily in the morning or to ranitidine 150 mg four times daily. At baseline and at 4 wk, patients underwent endoscopy for evaluation of esophageal lesions. Patients whose lesions healed by wk 4 had therapy discontinued; others remained on therapy and had repeat endoscopy at 8 wk. Also recorded at study visits were patients' ratings of heartburn symptoms and overall sense of well being, patients' reports of time lost from daily activities, antacid use, and adverse events. Serum gastrin levels were measured and argyrophil enterochromaffin-like cell histology evaluated at baseline and when the patient ended therapy.. At wk 4, healing was observed in 59% (98/167) of patients assigned to rabeprazole therapy, compared with 36% (60/169) of those receiving ranitidine (p < 0.001). By 8 wk, healing was seen in 87% (146/167) and 66% (112/169) of patients in the rabeprazole and ranitidine groups, respectively (p < 0.001). There were also significant differences between the two groups favoring rabeprazole with respect to resolution or improvement of heartburn symptoms and improvement in sense of well-being. No drug-related serious adverse events were seen with either therapy; fewer patients assigned to rabeprazole had treatment-emergent signs and symptoms. Serum gastrin levels increased over baseline in the rabeprazole group, but the mean value remained within normal limits.. Rabeprazole was superior to ranitidine in esophageal healing and symptom relief in patients with erosive gastroesophageal reflux disease, and was equally well tolerated.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Aged; Aged, 80 and over; Antacids; Benzimidazoles; Double-Blind Method; Female; Gastrins; Gastroesophageal Reflux; Heartburn; Histamine H2 Antagonists; Humans; Male; Middle Aged; Omeprazole; Proton Pump Inhibitors; Rabeprazole; Ranitidine; Treatment Outcome

We conducted a randomized, double-blind, multicenter clinical trial to determine whether lansoprazole was superior to continued therapy with histamine H2-receptor antagonist therapy in healing erosive reflux esophagitis.. Investigators from nine medical centers enrolled 159 patients with endoscopically documented esophageal erosions and/or ulcers that had failed to heal with 12 or more wk of at least standard dosages of histamine H2-receptor antagonist therapy. Patients received ranitidine 150 mg b.i.d. for 8 wk or lansoprazole 30 mg for 4 wk followed by either lansoprazole 30 mg or lansoprazole 60 mg for another 4 wk of treatment. Patients underwent endoscopy at screening and at weeks 2, 4, and 8.. At 2, 4, and 8 wk of therapy, healing rates were significantly higher in the lansoprazole group compared with the ranitidine group (p < 0.001). By 8 wk, 84% of the lansoprazole group were healed as opposed to only 32% of the ranitidine group. Lansoprazole was superior to ranitidine in providing relief of upper abdominal burning and daytime heartburn (p < 0.001) and reducing the need for antacids (p < 0.001). Lansoprazole patients had less interference with sleep and less day time drowsiness than ranitidine patients (p = 0.05). The percentages of patients with adverse events were similar in both groups. Fasting serum gastrin levels at weeks 4 and 8 were significantly higher in the lansoprazole group compared with the ranitidine group.. Eight weeks of lansoprazole therapy is safe, superior to continued ranitidine therapy, and effective in healing more than 80% of patients with erosive reflux esophagitis previously resistant to histamine H2-receptor antagonist therapy.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Aged; Antacids; Anti-Ulcer Agents; Double-Blind Method; Drug Resistance; Esophagitis, Peptic; Esophagoscopy; Fasting; Female; Follow-Up Studies; Gastrins; Heartburn; Histamine H2 Antagonists; Humans; Lansoprazole; Male; Middle Aged; Omeprazole; Ranitidine; Safety; Sleep; Sleep Stages; Ulcer; Wound Healing

Proton pump inhibitors (PPI) remain the leading therapy for acid-related disorders. Long-term PPI use increases the risk of pneumonia and enteric bacterial infections and of nosocomial Clostridium difficile-associated diarrhoea. PPIs do not lead to vitamin B12 or iron deficiencies and do not induce malignancies or increase the risk of major birth defects. Prolonged PPI use may be a weak risk factor for certain fractures and results in hypergastrinaemia and parietal cell hyperplasia leading to rebound acid hypersecretion, which may induce symptoms on withdrawal of therapy.

Topics: Anti-Ulcer Agents; Bacterial Infections; Congenital Abnormalities; Dyspepsia; Fractures, Bone; Gastrins; Gastroenteritis; Gastroesophageal Reflux; Heartburn; Humans; Neoplasms; Omeprazole; Pneumonia; Proton Pump Inhibitors; Risk Factors; Time Factors; Vitamin B 12 Deficiency

Withdrawal of proton pump inhibitors (PPIs) may induce symptoms in healthy volunteers, suggesting that discontinuing PPI therapy induces acid-peptic disease. Similar assessments in patients with documented acid-related disorders are lacking.. We performed a retrospective analysis of data from 287 Helicobacter pylori-negative erosive esophagitis (EE) patients healed after 4 or 8 weeks of therapy with dexlansoprazole modified release (MR) or lansoprazole, and then randomized to placebo in 6-month maintenance trials. We compared serum gastrin levels and 24-h heartburn severity before enrollment in the healing trials (baseline) and after receiving placebo in the 6-month maintenance trials.. Mean gastrin values at maintenance months 1 and 3 were essentially unchanged (median changes, 1.0 and -1.0 pg/ml), showing that gastrin normalized within 1 month of discontinuing PPIs and remained flat. Mean heartburn severity at maintenance month 1 was <1 on a 5-point scale (1=mild) and significantly lower than at baseline (median decrease, 0.41 points; P≤0.001). Heartburn severity in patients healed at week 4 or 8 with either PPI was generally similar, suggesting that neither longer exposure nor more potent therapy was associated with rebound. In those with month 2 data, mean heartburn severity at months 1 and 2 was significantly lower than baseline (median decrease, 0.54 and 0.58 points; both P<0.001), indicating an ongoing symptom response for 2 months after PPI withdrawal.. In H. pylori-negative EE patients, there was no indication of recurring heartburn symptom worsening beyond baseline levels within 2 months of discontinuing 4-8 weeks of PPI therapy.

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Adult; Aged; Dexlansoprazole; Esophagitis; Female; Gastric Acid; Gastrins; Heartburn; Humans; Lansoprazole; Male; Middle Aged; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Retrospective Studies; Severity of Illness Index; Withholding Treatment

Topics: Adrenocorticotropic Hormone; Carcinoma, Islet Cell; Cushing Syndrome; Diagnosis, Differential; Gastrins; Heartburn; Humans; Male; Middle Aged; Pancreas; Pancreatic Neoplasms; Tomography, X-Ray Computed

Gastroesophageal reflux has rarely been reported in the Zollinger-Ellison syndrome, presumably due to elevation in the lower esophageal sphincter pressure. We have evaluated 15 patients with the Zollinger-Ellison syndrome for evidence of esophageal disease. Five presented initially with esophageal disease: one, reflux symptoms; two, severe esophagitis; and two, strictures. Six of 15 had heartburn and nine of 15, objective evidence for reflux disease. Mean lower esophageal sphincter pressure was higher in the Zollinger-Ellison syndrome than in controls but was unrelated to serum gastrin levels. Zollinger-Ellison syndrome patients without heartburn had a higher mean sphincter pressure than did patients with heartburn (who had a mean sphincter pressure similar to that of controls but greater than that in patients with idiopathic gastroesophageal reflux). Four patients had biopsy evidence of esophagitis, one in association with Barrett's epithelium. Gastroesophageal reflux and its complications appear to be common in the Zollinger-Ellison syndrome.

Topics: Adult; Esophagogastric Junction; Esophagoscopy; Female; Gastrins; Gastroesophageal Reflux; Heartburn; Humans; Male; Manometry; Middle Aged; Prospective Studies; Zollinger-Ellison Syndrome

Heartburn was the major gastrointestinal symptom associated with drinking coffee in 31 subjects. These symptomatic subjects had a diminished basal lower-esophageal-sphincter (LES) pressure, 8.3 +/- 1.1 mm Hg, as compared with the pressure in asymptomatic subjects, 19.4 +/- 1.3 mm Hg (P less than 0.01), in response to four separate doses of coffee. LES pressure increased in normal subjects but changed only minimally in the symptomatic group (P less than 0.01). Basal acid output was similar in both groups, but the maximal acid response to coffee was paradoxically greater in normal subjects, 20.9 +/- 3.6 meq per hour, than in the symptomatic group, 9.4 +/- 1.5 meq per hour (P less than 0.01). During coffee instillation into the stomach, 26 of 31 symptomatic subjects (83 per cent) had heartburn at the highest dosage. Cimetidine, but not placebo, reduced acid secretion and heartburn in response to coffee, suggesting that acid was required for the development of symptoms. These studies suggest that LES dysfunction and gastroesophageal reflux, rather than gastric hypersection, are responsible for the heartburn caused by coffee in certain susceptible persons.

Topics: Adult; Aged; Cimetidine; Coffee; Digestive System; Esophagogastric Junction; Female; Gastric Juice; Gastrins; Gastrointestinal Diseases; Heartburn; Humans; Male; Manometry; Middle Aged; Placebos

To determine the effect of estrogenic and progesteronic activity on lower esophageal sphincter (LES) circular muscle, studies were performed on 20 adult opossums. Does-response curves on circular smooth muscle strips from the LES were constructed for gastrin and acetylcholine alone, and with 17beta-estradiol and/or progesterone added. Each female hormone significantly decreased the maximal LES muscle responses to gastrin and acetylcholine. A combination of 17beta-estradiol and progesterone abolished the response to gastrin. In contrast, the male sex hormone, dihydrotestosterone, had no effect. In conclusion, administration of estrogen and progesteron, but not dihydrotestosterone, in vitro reduced LES muscle responses to gastrin and acetylcholine. These studies suggest that the female sex hormones can alter LES function and potentially may be of importance in the pathogenesis of heartburn of pregnancy.

Topics: Acetylcholine; Animals; Dihydrotestosterone; Dose-Response Relationship, Drug; Drug Synergism; Esophagogastric Junction; Estradiol; Estrogens; Female; Gastrins; Heartburn; Male; Muscle, Smooth; Opossums; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Progesterone

Topics: Adolescent; Adult; Female; Gastrins; Gastroesophageal Reflux; Heartburn; Humans; Postpartum Period; Pregnancy

To determine whether lower esophageal sphincter (LES) function was normal during early pregnancy, studies were performed in 8 pregnant women before and after abortion. Resting LES pressures were 22.1 +/- 2.4 and 22.6 +/- 2.3 mm Hg before and after abortion, respectively. During early pregnancy the LES pressure responses to pentagastrin were inhibited significantly. The LES responses to edrophonium and methacholine were decreased also. Finally, LES pressure responses to a protein meal were diminished in an additional 5 pregnant women. Serum concentrations of estrogen and progesterone were elevated during pregnancy, but the serum concentration of gastrin was unchanged. It can be concluded that in early pregnancy the basal LES pressure was within normal limits, but the LES pressure responses to hormonal, pharmacological and physiological stimulation were reduced (during demonstrated elevations of serum concentrations of estrogen and progesterone). These studies suggest that during early pregnancy, when no clinical symptoms of reflux are present, altered LES function may be demonstrated.

Topics: Abortion, Induced; Adult; Edrophonium; Esophagogastric Junction; Estrogens; Female; Gastrins; Heartburn; Humans; Methacholine Compounds; Pentagastrin; Pregnancy; Pregnancy Complications; Pressure; Progesterone

Lower esophageal sphincter pressure, basal gastric pH, fasting plasma gastrin, and plasma concentrations of estrone, estradiol, and progesterone were measured in pregnant volunteers at 12, 24, and 36 weeks of gestation, and again at 1 to 4 weeks postpartum. In addition, basal and pentagastrin-stimulated acid secretory responses at each time were measured. No differences in basal gastric pH, basal, and peak acid outputs were observed during pregnancy when compared to the postpartum values. In contrast, lower esophageal sphincter pressure was reduced at all times during pregnancy, reaching a nadir at 36 weeks. Postpartum lower esophageal pressures were normal. As expected, plasma concentrations of progesterone and both estrogens increased progressively during pregnancy. These data are consistent with earlier studies in women ingesting oral contraceptives. Moreover, they provide support for the thesis that the progressive increase in plasma progesterone alone or in combination with estrogens that occurs during pregnancy is responsible for the reduction of lower esophageal sphincter pressure which allows esophageal reflux to occur with the resultant development of symptomatic heartburn.

Topics: Adolescent; Adult; Esophagitis, Peptic; Esophagogastric Junction; Estradiol; Estrone; Female; Gastrins; Heartburn; Humans; Hydrogen-Ion Concentration; Pregnancy; Pregnancy Complications; Pressure; Progesterone

Lower oesophageal sphincter pressure and fasting plasma gastrin and progesterone were measured in 31 women in the last trimester of pregnancy and in 10 healthy female control subjects. Eighteen of the pregnant women suffered from heartburn but 13 did not. All of the control subjects and 10 women from each of the two pregnant groups were tested for gastro--oesophageal reflux by direct measurement of intraluminal pH. The mean barrier pressure of the lower oesophageal sphincter was lower in both groups of pregnant women than in the controls (P less than 0-05) and the mean barrier pressure of the women with heartburn was lower than that of the pregnant women without heartburn, though this difference did not reach statistical significance. Eight of 10 of the pregnant women with heartburn had moderate or severe reflux, and3 of 10 of the pregnant women without heartburn also had moderate or severe reflux. Most women who reflux have heartburn, nevertheless, some asymptomatic women also reflux, and therefore all pregnant women must be considerered at risk from Mendelson's syndrome if subjected to a general anaesthetic for an emergency obstetric procedure.

Topics: Adolescent; Adult; Anesthesia, Obstetrical; Esophagogastric Junction; Esophagus; Female; Gastrins; Gastroesophageal Reflux; Heartburn; Humans; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Pressure; Progesterone; Stomach

Topics: Esophagogastric Junction; Female; Gastrins; Heartburn; Humans; Pregnancy; Pregnancy Complications

Topics: Adult; Aged; Bethanechol Compounds; Edrophonium; Esophagus; Female; Gastrins; Gastroesophageal Reflux; Heartburn; Humans; Male; Middle Aged; Muscles; Pressure; Stimulation, Chemical; Time Factors

Topics: Antacids; Esophagitis; Esophagoscopy; Esophagus; Gastrins; Gastroesophageal Reflux; Heartburn; Hernia, Diaphragmatic; Humans; Hydrogen-Ion Concentration; Parasympatholytics; Perfusion; Pressure; Radiography

Topics: Alkalies; Antacids; Bicarbonates; Esophagogastric Junction; Gastric Mucosa; Gastrins; Heartburn; Humans; Hydrochloric Acid; Intubation, Gastrointestinal; Monitoring, Physiologic; Pressure; Sodium; Sodium Hydroxide; Stimulation, Chemical