TOES Evaluations of Abstracts Submitted for the 69th Annual Scientific Meeting of the American College of Gastroenterology
American Journal of Gastroenterology, Vol. 99, No. 10, Suppl., 2004, ©2004 by Am. Coll. of Gastroenterology, ISSN 0002-9270/04/xx.xx, Published by Blackwell Publishing
October 29–November 3, 2004, Orlando, Florida
HISTAMINE-2 RECEPTOR ANTAGONISTS AT NIGHT IMPROVE GERD SYMPTOMS FOR PATIENTS ON PROTON PUMP INHIBITOR THERAPY
Andrew Rackoff, M.D., et al. Am J Gastro 2004:99 Suppl; A52.
Evidence-based info : A retrospective survey
Type of Study : Independent
Sample size : n = 39
Primary finding : Yes it helped in 7 of 10 patients and in most patients it seemed to keep helping. Tolerance seemed to develop in about 1 out of 10 patients and they stopped the H-2 blocker on their own.
Score of Study (TOES): = 10 out of 100
Is it consistent with what we already know? – Yes
Delayed release PPIs aren't in the bloodstream in sufficient concentration in the early morning hours due to their short half-life. Therefore, when the proton pumps come on (in the early morning) and start making acid - there is little to no PPI present to inhibit the proton pumps. However, H-2 blockers have a longer half-life and are present in the blood stream at that time (4am to 7am).
How should this effect your practice?
- Most persons with nighttime reflux symptoms benefit from an H2 blocker added at bedtime (e.g. PPI at 7 am and 5 pm and H2 at bedtime). But H2 blocker is not given at the same time as the PPI or else it will block the activity of the PPI. This is because histamine is the primary chemical mediator of parietal cell activation. Therefore, PPIs and H-2 blockers MUST be given at different times during the day.