Nocturnal gastric acid breakthrough in patients with duodenal ulcer

Objective To assess the incidence of noctu rnal acid breakthrough(NAB) and its' relationship with Helicobacter pylori(H. pylori) infection in patients with duodenal ulcer. Methods Forty duodenal ulcer patients were randomly allocated in to five groups. Patients were treated by intravenous injection of omeprazole 40 mg twice daily(group 1), once daily(group 2), omeprazole 20 mg twice daily oral ly(group 3), omeprazole 20 mg once daily orally(group 4), and intravenous inject ion of cimetidine 600 mg twice daily (group 5) all for 5 days. Intragastric pH o ver 24 hours was consecutively recorded on the fifth day for each patient. Results The mean intragastric pH, median intragastric pH, nocturn al mean pH and nocturnal median pH in group 1(6.9±0.7,7.3±0.8,6.8±0.9,7.1± 0 .7) were significantly higher than those of group 2 (5.3±1.6,5.6±1.7,4.9±1. 5,4.3±1.7),group 4(4.8±0.7,4.8±1.0,4.7±0.8,4.5±0.8), and group 5(4.4±2.4 ,4.5±2.5,4.6±2.7,4.3±2.1), but not higher than group 3(6.2±0.7,6.3±0.8,6. 4±1.1,6.4±0.8). High intragastric pH was produced in all five groups. The frac tion time of pH below 4.0 in group 1(3.1%) and group 3(4.5%) were significantly fewer than that in the other three groups(group 2,27.8%; group 4, (32.4)%, and group 5,48.2%) respectively. NAB occurred in 1 patient from two omeprazole twice dai ly groups(6.3 %, group 1 and 3) and in 9 patients from two omeprazole once daily groups((56.3 %,) group 2 and 4,P0.05). The incidence of NAB in H. pylori negative pat ients (55.6%) was significantly higher than that in H. pylori positive(13.6% ) patients(P0.05). Conclusions (NAB) (occurred) less common in Chinese patients w ith duode nal ulcer than patients in western countries. (Dose) (and) (methods) of omeprazole adm inistration and the status of H.pylori infection status appeared to be (clo sely) (related) to the (incidence) of NAB.