Curbside Consultation in GERD: 49 Clinical Questions

Philip O. Katz, MD

Question 35: What Is Nocturnal Acid Breakthrough, And What Is Its Clinical Importance? Is Zegerid Really Any More Effective In This Group? (continued)

This controversial and misunderstood concept has received much attention since the first report that 70% of patients (or normals) demonstrate a drop in the intragastric pH < 4 for at least 1 continuous hour in the overnight monitoring period (10 pm to 6 am) despite taking a proton pump inhibitor twice daily. Termed nocturnal gastric acid breakthrough (NAB) occurs most often about 6 to 7 hours after the evening dose of the proton pump inhibitor (PPI), principally between 1 and 4 am on twice-daily PPI. When PPIs are given once daily before breakfast, breakthrough occurs earlier, beginning…