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Biomedical subjects

D O Castell

Publications and source records attributed to D O Castell.

At least 73 records · Page 4Linked to original sources
PubMed1999

Bedtime ranitidine does not eliminate the need for a second daily dose of omeprazole to suppress nocturnal gastric pH.

BACKGROUND: We have previously shown that 70% of patients experience nocturnal gastric acid breakthrough (defined as pH<4 for more than 60 min between 22.00 and 06.00 hours) on twice a day (b.d.) proton pump inhibitor. Adding 150 or 300 mg of ranitidine at bedtime is more effective than additional omeprazole at bedtime in control of night-time acid breakthrough. AIM: To assess whether omeprazole 20 mg AM plus ranitidine 150 mg HS would be as effective as omeprazole 20 mg before breakfast and dinner (b.d. AC) in intragastric pH control, particularly during the overnight period. METHODS: Twenty healthy volunteers (11 males, 9 females, mean age 32.7 years) were treated with omeprazole (OME) 20 mg b.d. AC and placebo HS or omeprazole 20 mg AM and placebo before dinner plus ranitidine (RAN) 150 mg HS for 7 days, in a randomized, double-blind, crossover design, with a 1 week washout between study periods. On day 8 subjects were monitored for 24 h with a single channel pH probe placed in the stomach 10 cm below the proximal border of the LES. Percentage time pH<4 for total, upright and recumbent positions were compared between the two regimens using Wilcoxon matched pairs testing. RESULTS: Expressed in median values of percentage time pH<4: upright time intragastric pH<4 on OME 20 mg b.d. AC was 18.9 compared to 29.7 on OME AM + RAN HS (P = 0.003). Recumbent time pH<4 on OME 20 mg b.d. AC was 23.45 compared to 44.75 on OME AM + RAN HS (P = 0.02). CONCLUSION: Bedtime ranitidine does not eliminate the need for an evening dose of omeprazole to control intragastric pH in patients requiring more than a single daily dose of omeprazole.

Adult↗
PubMed1999

Post-prandial ranitidine is superior to post-prandial omeprazole in control of gastric acidity in healthy volunteers.

BACKGROUND: Episodic heartburn is a common problem, affecting over 40 million Americans. Although omeprazole provides excellent acid suppression when used daily, the use of omeprazole as on-demand therapy for episodic symptoms has not been extensively studied. AIM: To compare the onset and duration of post-prandial gastric acid suppression by omeprazole (10 and 20 mg) or ranitidine (75 and 150 mg) taken as single doses in healthy volunteers. METHODS: Twenty-four healthy volunteers (14 male, 10 female, mean age 33.4 years, range 18-56 years) were given ranitidine (RAN) 75 mg or 150 mg vs. omeprazole (OME) 10 mg or 20 mg when pH returned to below 2 after breakfast, in a randomized open label crossover design, with a washout of at least 2 days between medications. Intragastric pH was monitored for 6 h. The time between drug ingestion and rise of gastric pH > 3 and 4, and total time pH remained > 3 and 4 during the 6 h post drug, was compared between groups using two way ANOVA and Wilcoxon matched pairs test. RESULTS: The median time needed to pH > 4 was 204.5 min for RAN 75 mg, 186 min for RAN 150 mg and > 360 min for both OME 10 and 20 mg (P < 0.001 between the four groups). The median time that pH remained > 4 was 93 min for RAN 75 mg, 143.5 min for RAN 150 mg and 0 min for both OME 10 and 20 mg (P < 0.001 between the four groups). Both doses of RAN were significantly superior to both doses of OME, although no significant difference was found between the high and the low doses of either drugs. Similar results were found for pH > 3. CONCLUSION: Ranitidine 75 or 150 mg provides more rapid increase in gastric pH to > 3 and > 4 compared to omeprazole 10 or 20 mg when taken at the end of the post-prandial period. These data suggest that ranitidine may be more effective for episodic post-prandial heartburn than omeprazole.

Adolescent↗
PubMed1999

Oesophageal motility defects associated with nocturnal gastro-oesophageal reflux on proton pump inhibitors.

BACKGROUND: Recent studies from our laboratory reveal that 70% of patients with gastro-oesophageal reflux disease (GERD) on proton pump inhibitors twice daily (b.d.) have nocturnal gastric acid breakthrough (gastric pH < 4 > 1 h) which is often accompanied by oesophageal acid exposure. The pathogenesis of GER during gastric acid breakthrough is not clear. AIM: To determine the prevalence of oesophageal motility abnormalities in patients with nocturnal GER associated with nocturnal acid breakthrough on proton pump inhibitor b.d. METHODS: We reviewed the pH-metry and manometric studies of 100 consecutive patients with GERD who were on proton pump inhibitor b.d. pH tracings were analysed for the nocturnal period (10.00 hours until 06.00 hours). Nocturnal GER was defined as> 0.5% time distal oesophageal pH < 4. Manometric tracings were reviewed for lower oesophageal sphincter (LES) pressure and oesophageal body motility. Chi-squared and Fischer's test were used for statistical analysis. RESULTS: Of the 100 patients, 74 (74%) had nocturnal gastric acid breakthrough. Thirty-one (42%) had concurrent abnormal nocturnal GER (refluxers) and 43 out of 74 (58%) had no GER (non-refluxers). The prevalence of ineffective oesophageal motility, and low LES pressure was significantly higher in refluxers than in non-refluxers (P < 0. 05, P < 0.001, respectively). Ineffective-oesophageal motility has a high specificity (91%), but low sensitivity (45%) as a diagnostic predictor for patients who are more likely to develop nocturnal GER on proton pump inhibitor b.d. CONCLUSION: Ineffective oesophageal motility is a risk factor for proton pump inhibitor refractory GER.

Adolescent↗
PubMed1999

Effects of octreotide on esophageal visceral perception and cerebral evoked potentials induced by balloon distension.

OBJECTIVE: Octreotide, a somatostatin analog, is antinociceptive and increases perception threshold in the rectum. The aim of this study was to determine whether octreotide alters esophageal sensory thresholds and cortical evoked potentials (CEPs) resulting from intraesophageal balloon distension. METHODS: Twelve healthy volunteers (six men and six women, median age 25 yr, range 21-60 yr) underwent a randomized, double-blind, placebo-controlled trial of octreotide 100 microg s.c. versus saline. A 30-mm balloon was inserted 5 cm above the lower esophageal sphincter without topical anesthesia. The balloon was inflated at a rate of 170 cc/s to a maximum of 30 cc in 2 cc steps. Both pressure and volume were recorded. Patients reported first sensation (S1) and maximally tolerated pain (S2). Two cycles were performed both preinjection and 40 min postinjection. Evoked potentials were recorded from Cz to linked ears over 50 balloon inflation cycles (volume = S2). RESULTS: Threshold volume to first sensation (S1) was significantly increased after octreotide injection [median (interquartile range): 24 (14-26) cc vs 13 (9-21) cc, p < 0.02]. No significant alteration in volume causing pain (S2) was noted after octreotide injection [29 (25-30+) cc vs 22 (19-29) cc]. Neither were volumes causing either first sensation [18 (11-24) cc vs 13 (9-18) cc] or pain [27 (23-30) cc vs 23 (21-25) cc] significantly altered by placebo injection. Neither amplitude nor latency of any of the three peaks of the evoked potential recordings differed significantly between postplacebo and postoctreotide recordings. CONCLUSION: Octreotide significantly increased esophageal perception thresholds to balloon distension. It did not alter pain thresholds, nor were cortical evoked potentials to painful stimulation altered in normal subjects.

Adult↗
PubMed1999

Use of botulinum toxin as a diagnostic/therapeutic trial to help clarify an indication for definitive therapy in patients with achalasia.

OBJECTIVE: Intrasphincteric injection of botulinum toxin is useful in achalasia but is limited by its short term efficacy. The aim of this study was to evaluate the use of botulinum toxin in selected patients in whom its short duration of action may be useful in guiding therapy before considering more invasive procedures that might not be indicated. METHODS: Over a 3 yr period, botulinum toxin was injected into the lower esophageal sphincter in patients with: 1) symptoms consistent with achalasia but insufficient manometric criteria to make the diagnosis; 2) complex clinical situations in which there were factors in addition to achalasia that may be contributing to the patient's symptoms and that required different treatment; 3) atypical manifestations of achalasia; 4) advanced achalasia in which it was unclear that sphincter-directed therapy (vs esophagectomy) would be of benefit; and 5) after Heller myotomy. Clinical response was assessed mostly by symptom improvement, but in some patients follow-up barium swallow or radioscintigraphy was available. RESULTS: Eleven patients were identified. Ten had complete symptomatic response to the injection. Two patients have undergone subsequent successful pneumatic dilation, one a successful laparoscopic myotomy, and another currently scheduled for surgical myotomy. The only patient without response had advanced achalasia requiring esophagectomy. CONCLUSIONS: Intrasphincteric injection of botulinum toxin into the lower esophageal sphincter is a useful and safe means of guiding therapy in those patients with a variant of achalasia, atypical achalasia, or complex achalasia in which it is unclear that more invasive procedures such as pneumatic dilation or surgical myotomy are the correct therapy.

Adult↗
PubMed1999

Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease.

OBJECTIVE: Body position has been shown to influence postprandial and fasting gastroesophageal reflux (GER) in patients and normal volunteers when they are assigned to lie in a prescribed position. No published studies have evaluated the effect of spontaneous sleeping positions on recumbent reflux in patients with GER. METHODS: Ten patients, three female and seven male (mean age 47.6 yr, range 30-67 yr) with abnormal recumbent esophageal pH <4 on 24-h pH-metry participated. A standardized high fat dinner (6 PM) and a bedtime snack (10 PM) were administered to all patients. GER during spontaneous sleep positions was assessed with a single channel pH probe placed 5 cm above the lower esophageal sphincter (LES) and with a position sensor taped to the sternum. Data were recorded with a portable digital data logger (Microdigitrapper-S, Synectics Medical) and analyzed for recumbent percent time pH <4 and esophageal acid clearance time in each of four sleeping positions. Time elapsed between change in sleeping position and GER episodes was also calculated. RESULTS: Right lateral decubitus was associated with greater percent time pH <4 (p < 0.003) and longer esophageal acid clearance (p < 0.05) compared to the left, supine, and prone. GER episodes were more frequent in the supine position (p < 0.04) and occurred within 1 min after change in sleeping position 28% of the time. CONCLUSIONS: The left lateral decubitus position is preferred in patients with nocturnal GER. Measures to aid patients in sleeping in this position should be developed.

Adult↗
PubMed1999

Massively dilated esophagus in achalasia: response to pneumatic balloon dilation.

OBJECTIVE: Pneumatic balloon dilation is considered by many to be the treatment of choice for achalasia of the esophagus. Patients with untreated, long standing achalasia may develop massively dilated esophagi, sometimes difficult to dilate with a pneumatic balloon and, rarely, may require esophagectomy. We present our experience with nine such patients out of 110 who underwent pneumatic dilation. METHODS: Of 110 patients treated for achalasia by pneumatic balloon dilation, from January 1989 until December 1996, nine patients had massively dilated esophagi with transverse diameter >7 cm. Results of these patients are presented with pre- and postdilation symptom scores and barium esophagograms. This study was conducted at the Department of Gastroenterology, Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan. A Microvasive Rigiflex 35 mm (Boston Scientific, Watertown, MA) pneumatic balloon was used for dilation. RESULTS: Although it is often tedious to perform pneumatic dilation in massively dilated esophagus, it was possible to dilate adequately, in all nine cases without complications, with good symptomatic improvement at 12-month follow-up. CONCLUSIONS: We recommend pneumatic balloon dilation in achalasia with massively dilated esophagus as a first line treatment, the failure of which requires surgical intervention.

Adult↗
PubMed1999

Ineffective esophageal motility: the most common motility abnormality in patients with GERD-associated respiratory symptoms.

OBJECTIVE: The association of gastroesophageal reflux disease (GERD) and respiratory symptoms is well known. The coexistence of ineffective esophageal motility (IEM, low-amplitude [< 30 mm Hg] or nontransmitted contractions in > or = 30% of 10 wet swallows in the distal esophagus) in patients with GERD has recently been demonstrated. Our aim was to determine the prevalence of IEM in patients with GERD-associated respiratory symptoms. METHODS: Manometry and pH studies of 98 consecutive patients with respiratory symptoms and abnormal reflux shown by pH-metry were reviewed. Symptoms were chronic cough (n = 43), asthma (n = 13), and laryngitis (n = 42). Sixty-six patients with heartburn with no extraesophageal manifestations were used as a control group. Total esophageal acid clearance (EAC) time was calculated for each patient. RESULTS: IEM was the most common motility abnormality seen in all groups of GERD patients. It was seen significantly more often in patients with chronic cough (41%) (p = 0.003) or asthma (53%) (p = 0.01), and numerically more often in patients with laryngitis (31%) than in patients with heartburn (19%). Diffuse esophageal spasm and nutcracker esophagus were rarely seen. Incidence of hypertensive or hypotensive lower esophageal sphincter was similar across all groups. The total EAC time was longer (median: 1.51 min/episode) (p = 0.01) in patients with GERD-associated respiratory symptoms than in patients with heartburn (median: 0.72 min/episode). CONCLUSIONS: IEM is the most prevalent motility abnormality in patients with GERD-associated respiratory symptoms. Coexistence of IEM with GER may place patients at high risk for respiratory symptoms due to the associated delayed esophageal acid clearance seen with this motility abnormality.

Adolescent↗
PubMed1999

Different effects of an oral anticholinergic drug on gastroesophageal reflux in upright and supine position in normal, ambulant subjects: a pilot study.

OBJECTIVE: There is controversy in the literature on the effects of anticholinergic drugs on gastroesophageal reflux. Our aim was to study more extensively the effects of an oral anticholinergic drug on esophageal motility and gastroesophageal reflux in normal ambulant subjects under different circumstances: upright, supine, fed, and fasted state. METHODS: Fifteen healthy subjects (seven men, eight women), mean age 34 yr (range, 22-61 yr) underwent randomized placebo-controlled 16-h evening and overnight ambulatory esophageal motility/pH study. After a 3-day loading dose of either oral dicyclomine (Dic) 20 mg four times daily or placebo (Pla), an ambulatory esophageal motility/pH study was performed while taking medication or placebo. Each study was analyzed for meal, first and second h postprandial, upright and supine periods, and first 2 h supine after bedtime snack. RESULTS: The mean number of reflux episodes decreased with dicyclomine during the first h postprandial (Dic, 1.9 vs Pla, 2.5; p < 0.05). During the first 2 h supine, mean number of reflux episodes increased with dicyclomine (Dic, 1.4 vs Pla, 0.8; p < 0.09), as did mean percent time pH < 4 (Dic, 2.6 vs Pla, 0.5; p < 0.04), with an increase in clearance time (Dic, 0.9 vs Pla, 0.3; p < 0.05; in min). Mean peristaltic amplitude decreased with dicyclomine during the 2nd h postprandial (Dic, 48.8 vs Pla, 56.3; p < 0.04). CONCLUSIONS: Oral dicyclomine caused a decrease in early postprandial upright reflux episodes, but also significantly increased the percent time pH < 4 during the first two h supine. Therefore, its effects are dependent on body position and fasted or fed state. Our results justify additional studies with oral anticholinergic agents in patients with gastroesophageal reflux disease.

Administration, Oral↗
PubMed1998

Ranitidine controls nocturnal gastric acid breakthrough on omeprazole: a controlled study in normal subjects.

BACKGROUND & AIMS: Proton pump inhibitors administered twice daily do not provide complete nocturnal acid suppression. Acid breakthrough, or decrease in intragastric pH to <4 for an hour or longer, occurs in three quarters of normal subjects and patients at night. We compared the effect of a third dose of omeprazole at bedtime with that of a dose of ranitidine at bedtime on residual nocturnal acid secretion in patients receiving omeprazole twice daily. METHODS: Twelve volunteers underwent overnight intragastric pH monitoring after 7 days of treatment with omeprazole, 20 mg twice daily, followed by different treatment supplements at bedtime: placebo; additional omeprazole, 20 mg; ranitidine, 150 mg; and ranitidine, 300 mg. RESULTS: Additional omeprazole at bedtime reduced the percentage of time with intragastric pH of <4 from 48% to 31% (P < 0.005) compared with omeprazole twice daily with placebo at bedtime. Ranitidine at bedtime reduced this parameter more, 5% with 150 mg and 6% with 300 mg (P <0.01 vs. omeprazole twice daily plus bedtime). Results for percentage of time with intragastric pH <3 were similar. Eleven subjects had acid breakthrough with placebo at bedtime; 7 with omeprazole at bedtime (P = NS); 4 with ranitidine, 150 mg at bedtime; and 3 with ranitidine, 300 mg at bedtime (P < 0. 05, ranitidine vs. placebo). CONCLUSIONS: Bedtime ranitidine is more effective than bedtime omeprazole on residual nocturnal acid secretion in patients receiving omeprazole twice daily. This finding suggests that fasting breakthrough nocturnal acid secretion in patients receiving omeprazole twice daily is most likely histamine related.

Adult↗
PubMed1998

Acid secretion from an esophageal inlet patch demonstrated by ambulatory pH monitoring.

Heterotopic gastric mucosa may occur throughout the gastrointestinal tract, including the upper esophagus. The capability of this ectopic mucosa to secrete acid has been suggested in different reports. We report for the first time a case of heterotopic gastric mucosa in the upper esophagus complicated by a stricture with secretion of acid demonstrated by prolonged ambulatory pH monitoring. Lansoprazole, 30 mg twice daily, produced symptom resolution, and repeat ambulatory pH showed complete acid suppression in the proximal esophagus.

Adult↗
PubMed1998

Gastroesophageal reflux disease during pregnancy.

Pregnant patients with symptomatic GERD should be managed aggressively with lifestyle modification and dietary changes. Antacids and antacids/alginic acids combination or sucralfate should be considered first-line medical therapy. If symptoms are not adequately relieved or complications develop, treatment with cimetidine or ranitidine should be considered; these H2 receptor antagonists are preferred during pregnancy. Nizatidine cannot be recommended. Proton-pump inhibitors should be used with caution because little human experience is available. Despite this caveat, both proton-pump inhibitors are likely to be safe during pregnancy.

Female↗
PubMed1998

Globus sensation is associated with hypertensive upper esophageal sphincter but not with gastroesophageal reflux.

Globus sensation (globus) is best described as a constant feeling of a lump or fullness in the throat. Although the etiology of globus remains unclear, it has been attributed to a hypertensive upper esophageal sphincter (UES) resting pressure and to gastroesophageal reflux (GER). The aim of this study was, therefore, to determine if significant associations existed among globus, UES resting pressure, and GER. We reviewed the records of all patients who had stationary esophageal manometry over a 21/2-year interval with specific attention to symptoms of globus, UES pressures, and ambulatory pH studies. Patients with hypotensive UES (<30 mm Hg) were excluded. Chi square (chi2) test was used to determine significant associations. Six hundred fifty patients had normal UES resting pressures and 101 patients had hypertensive UES (>118 mm Hg). Seventeen of the 650 (3%) (16 women/1 man; mean age: 48, range 32-81 years) with normal UES described globus. Conversely, 28 of the 101 (28%) (15 women/13 men; mean age: 43, range 23-61 years) patients with hypertensive UES described globus. There was a significant association between hypertonicity of the UES and globus (chi2=93.42, P < 0.0001). In patients with normal UES, globus occurred predominantly in females (chi2=6.33, P < 0.01). Twenty-three (16 women/7 men; mean age: 43, range 23-60 years) of the 45 patients with globus had prior ambulatory pH studies. Six of 23 (26%) had GER. Compared to an age-, sex-, and UES-pressure-matched group of 23 patients (16 women/7 men; mean age: 44, range 22-75 years) without globus, nine (39%) had GER, thus showing no significant association of globus with GER (P=0.35). There also was no significant association of GER with normal UES or with hypertensive UES in these patients. In conclusion, there is a significant association between hypertensive UES and globus. The data suggest two possible etiologies: female patients with normal UES pressure potentially having increased afferent sensation and a group with equal sex distribution but abnormally elevated UES resting pressure. This study does not support GER as an etiology of globus.

Adult↗
PubMed1998

Pneumatic dilatation is effective long-term treatment for achalasia.

Although pneumatic dilatation (PD) has been an established treatment for achalasia for decades, there is limited information on its long-term clinical efficacy. We have followed up the clinical status of patients having PD with a 30- or 35-mm balloon by one of us (D.O.C.) over a 25-year period. Of 144 patients whose initial records were available for review, 31 could not be contacted. Of the remaining 113 patients, 72 (64%) responded to a questionnaire assessing swallowing status and patient satisfaction, and this forms the basis of this report. There were 32 men and 40 women, with mean age 46 years (range: 17-78); mean length of follow-up since PD was 6.5 years (range: 10 months to 25 years). Success was primarily defined by the need for no additional therapy for achalasia other than one or two PD's. PD was effective long-term treatment in 61/72 patients (85%); only four of these required a second PD over this time interval. There was no significant difference in any of the following parameters between patients with a treatment success or failure: age, sex, size of pneumatic dilator, and duration of symptoms prior to PD. Response was significantly better (P < 0.05) in patients having no prior dilatation (43/47; 91%) than in those in whom another physician had performed prior dilatation (18/25; 72%). In response to the question of whether they would select PD again, 68 patients (94%) responded positively. In conclusion, pneumatic dilatation performed using a consistent technique by an experienced physician is effective long-term therapy for achalasia patients of all ages. Most patients require only one dilatation.

Adolescent↗
PubMed1998

Gastro-oesophageal reflux associated with nocturnal gastric acid breakthrough on proton pump inhibitors.

BACKGROUND: Nocturnal gastric acid breakthrough, defined as intragastric pH < 4 for more than 1 h in the overnight period, is observed in up to 70% of normal subjects on proton pump inhibitors taken twice daily. The frequency of this breakthrough in patients with gastro-oesophageal reflux and accompanying oesophageal reflux during this period has not been studied. AIM: To examine the frequency of nocturnal break-through and accompanying oesophageal acid exposure in patients with gastro-oesophageal reflux treated with proton pump inhibitors twice daily. METHODS: Prolonged ambulatory pH records from 76 patients on twice daily proton pump inhibitors between January 1991 and July 1997 were analysed for the presence of nocturnal gastric acid breakthrough and accompanying oesophageal pH < 4. Studies from 31 normal subjects on twice daily proton pump inhibitors constituted the control group. RESULTS: Nocturnal gastric acid breakthrough was seen in 70% of 61 patients with gastro-oesophageal reflux, 80% of 15 patients with Barrett's oesophagus and 67% of normal controls (P=N.S.). Oesophageal acid exposure was seen in 33% of gastro-oesophageal reflux patients, 50% of Barrett's oesophagus patients and 8% of normal controls (P < 0.03). No difference was found between patients taking omeprazole or lansoprazole. CONCLUSION: Nocturnal acid breakthrough is frequently seen on proton pump inhibitors twice daily and is often accompanied by oesophageal reflux. This has important implications for medical therapy in patients with severe gastro-oesophageal reflux and Barrett's oesophagus.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1998

Nocturnal gastric acidity and acid breakthrough on different regimens of omeprazole 40 mg daily.

BACKGROUND: On chronic intake of omeprazole, most healthy volunteers and patients still have nocturnal acid breakthrough (NAB), defined as night-time periods with gastric pH < 4.0 lasting for longer than 1 h. Gastro-oesophageal reflux during NAB may be particularly injurious to the oesophageal mucosa, contributing to the chronic lesions complicating the condition. AIM: To compare the effect of three different dosing regimens of omeprazole 40 mg daily with regard to suppressing nocturnal gastric acidity and avoiding NAB. METHODS: Eighteen healthy volunteers were given three different regimens of omeprazole for 7 days each in randomized order: 40 mg before breakfast (qAM), 40 mg before dinner (qPM) and 20 mg before breakfast and dinner (b.d.). On day 7, 24-h intragastric and intraoesophageal pH-metry was performed. Tracings were analysed for the period from 22.00 h until 06.00 h with regard to the percentage of time at which gastric pH was below 4.0, 3.0 and 2.0, and also the occurrence and duration of NAB. RESULTS: Nocturnal acid breakthrough was significantly more common on qAM than on qPM and b.d. (P < 0.05) dosing. The percentage of time gastric pH was less than 4.0 overnight was significantly lower on qPM (median 31.3) and b.d. (median 20.5) than on qAM (median 66.3) dosing (P=0.01 and P < 0.02, respectively). A pH threshold of 3 and 4 showed the same differences, as did median 24-h gastric pH. Daytime acidity was not significantly different. CONCLUSIONS: In healthy volunteers, dinner time or split dosing of omeprazole 40 mg daily is significantly more effective than dosing before breakfast in preventing NAB and controlling gastric acidity. These regimens should be preferred in patients in whom suppression of nocturnal gastric acidity is desirable.

Adult↗