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Background and Aims: A pH of more than 6 is required for clot stability and hemostasis. Intravenous proton pump inhibitors have a rapid onset of action compared to oral and have been preferred for management of non-variceal bleeding. Intravenous pantoprazole has been used extensively. Buffered esomeprazole (BE) is an oral preparation consisting of an inner core of non-enteric-coated esomeprazole with a shell of sodium bicarbonate. The buffer protects against acid degradation of esomeprazole in addition to immediate antacid action. The aim of this study was to assess the efficacy of BE for raising and maintaining an intragastric pH of more than 6 in comparison to i.v. pantoprazole in equivalent dosing. Methods: A randomized two-way cross-over study was conducted. Ten healthy volunteers were randomized to twice daily BE 40 mg or pantoprazole 40 mg i.v. bolus. Intragastric pH was measured with a wireless pH radiotelemetry capsule (Bravo, Medtronic). A 2-week washout period was given between doses. Results: BE achieved a steady pH of more than 6 in a median time of 2 min (range 1–5 min) after the first dose. The mean % time that intragastric pH was more than 6.0 for BE was 96%, and 90% of the 24-h period compared to pantoprazole (47% and 18%), P = 0.000. A median pH (interquartile range) for the BE group was 6.2 (6.175–6.2) which was higher than i.v. pantoprazole 4.60 (4.5–5.0) (P = 0.005). Conclusion: BE achieves and maintains a pH of more than 6 within minutes of administration. It was significantly superior to i.v. pantoprazole in equivalent dosing. This finding could have implications in the management of non-variceal bleed where a rapid and sustained pH of more than 6 is desirable.

Summary Background H2-receptor antagonists are widely used with proton pump inhibitors. Aim To determine if H2-receptor antagonists used in conjunction with proton pump inhibitors were effective for nocturnal heartburn in patients taking proton pump inhibitors. Methods We evaluated 386 patients with erosive oesophagitis documented at endoscopy who were receiving single daily maintenance proton pump inhibitor therapy to determine if they had symptoms of nocturnal heartburn. Patients with two or more episodes of night-time a week were invited to participate in the study. Patients were randomly assigned to a single dose of an over-the-counter preparation of ranitidine 75 mg at bedtime or matching placebo for 14 days. Results The prevalence of nocturnal symptoms was 10.6%. Mean symptom scores on the first day of the trial (baseline) were similar between the treatment group (1.1 ± 0.9) and the placebo group (1.1 ± 1.1). On day 3, symptom scores were significantly lower in the ranitidine group (0.71 ± 0.69) compared with the control group (1.4 ± 1.2; P = 0.045). On day 14, mean symptom scores were similar in the ranitidine group (0.82 ± 0.95) and the control group (1 ± 0.84). Conclusions Nocturnal heartburn is uncommon on proton pump inhibitor therapy; the addition of ranitidine at bedtime resulted in a decrease in symptom scores on day 3 but there were no differences on day 14.

SUMMARY Introduction : Nocturnal acid reflux is common and could disturb sleep by causing arousals that fragment sleep. Aim : To determine the prevalence of gastro-oesophageal reflux symptoms and their association with arousals, stages of sleep and quality of life in patients undergoing evaluation for excessive daytime sleepiness and obstructive sleep apnoea. Methods : Ninety-four consecutive patients with excessive daytime sleepiness were prospectively studied. Patients completed the gastrointestinal symptom rating scale, a validated symptom questionnaire for reflux disease and a disease-specific quality of life questionnaire, the sleep apnoea quality of life index and then underwent overnight polysomnography, which was read in a blinded manner. Results : There were 40 males and 54 females with a mean age of 47 ± 13 years. Reflux symptoms were present in 63 of the 94 (67%) patients. Patients with reflux symptoms had significantly more arousals from sleep 43 ± 70/h than those without (20 ± 24/h; P =0.03). The sleep duration during the second stage of sleep was shorter (44 ± 21%) for those with reflux symptoms than those without (52 ± 12%; P = 0.03). Patients with reflux spent significantly shorter periods in stage II sleep (44 ± 21%) than those without (52 ± 12%; P = 0.03). The sleep-related quality of life score in patients with gastro-oesophageal reflux (3.1 ± 1.1) was significantly lower than in patients without reflux (3.7 ± 1.0; P = 0.02). Regression analysis demonstrated a significant inverse correlation between quality of life and reflux symptom score (P =0.002) and total spontaneous arousals (P = 0.04). Conclusions : Gastro-oesophageal reflux is common in patients with sleep disorders, is associated with increased arousal, decreased durations spent in the deeper stages of sleep and poorer sleep-related quality of life.