J Neurogastroenterol Motil  
Esophageal Acidification During Nocturnal Acid-breakthrough with Ilaprazole Versus Omeprazole in Gastroesophageal Reflux Disease
Arun Karyampudi, Uday C Ghoshal*, Rajan Singh, Abhai Verma, Asha Misra, and Vivek A Saraswat
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
Correspondence to: Uday C Ghoshal, MD, DNB, DM, FACG, RFF
Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India
Tel: +91-522-2494405, Fax: +91-522-2668017 or 2668078, E-mail: udayghoshal@gmail.com
Received: May 21, 2016; Revised: July 16, 2016; Accepted: July 28, 2016; Published online: September 1, 2016.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims
Though nocturnal acid-breakthrough (NAB) is common in gastroesophageal reflux disease (GERD) patients, its clinical importance results from esophageal acidification, which has been shown to be uncommon. Ilaprazole, a long-acting proton pump inhibitor, may cause NAB infrequently. Accordingly, we studied prospectively, (1) frequency and degree of esophageal acidification during NAB, and (2) frequency and severity of NAB while on ilaprazole versus omeprazole.
Methods
Fifty-eight consecutive patients with GERD on once daily ilaprazole, 10 mg (n = 28) or omeprazole, 20 mg (n = 30) for > one month underwent 24-hour impedance-pH monitoring prospectively. NAB was defined as intra-gastric pH < 4 for > one hour during night and esophageal acidification as pH < 4 for any duration. Nocturnal symptoms (heartburn, regurgitation, and chest pain) were also recorded.
Results
Of 58 patients (age 35.5 [inter-quartile range 26.5-46.0] years, 38 (65.5%) male), 42 (72.4%) had NAB. Though patients with NAB had lower nocturnal intra-gastric pH than without (2.8 [1.9- 4.1] vs 5.7 [4.6-6.8], P < 0.001), frequency and duration of nocturnal esophageal acidification (17/42 vs 4/16, P = 0.36 and 0.0 [0.0-1.0] vs 0.0 [0.0-0.3] minutes, P = 0.26, respectively) and symptoms were comparable (13/42 vs 6/16, P = 0.75). Though ilaprazole was associated with less NABs (1 [range 1-2, n = 19] vs 1 [range 1-3, n = 23], P = 0.01) than omeprazole, frequency, duration, and mean intra-gastric pH during NAB were comparable (19/28 vs 23/30, P = 0.56; 117 [0-315] vs 159 [69-287] minutes, P = 0.5; 1.02 [0.7-1.4] vs 1.04 [0.44-1.3], P = 0.62, respectively).
Conclusions
Though NAB was common while on proton pump inhibitor, esophageal acidification was uncommon. Frequency and severity of NAB were comparable among patients on ilaprazole and omeprazole except for lesser number of NABs.
Keywords: 24-hour impedance-pH monitoring; Heartburn; Proton pump inhibitors; Intra-gastric pH


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