THE EFFECTIVENESS OF PROTON PUMP INHIBITORS PRIMARILY IN THE TREATMENT OF PATIENTS WITH ACID-DEPENDENT GASTROESOPHAGEAL DISEASES DEPENDS ON THE BASAL SECRETION OF HYDROCHLORIC ACID.

Abstract

Introduction: The resistance of Helicobacter pylori (H.p.) to eradication therapy schemes is relevant for modern gastroenterology. One of the ways to overcome this problem is to achieve sufficient blocking of HCl secretion in the stomach. However, in not all patients with acid-dependent gastroesophageal diseases, we can achieve blockade of gastric HCl secretion using standard doses of proton pump inhibitors (PPIs). Thus, it becomes relevant to develop criteria for predicting the effectiveness of PPIs before the eradication of H.p. Aim: Based on the data of daily gastro-pH monitoring, evaluate the effectiveness of PPI on the first day of treatment depending on the basal secretion of HCl. Methods: We analyzed 83 results of daily gastro-pH monitoring on the first day of taking PPIs in patients with aciddependent gastroesophageal diseases. The separation criterion was the indicators of express gastro-pH monitoring (Х pH ˃2.48 units, Me pH ˃2.3 units and Mo pН ˃2.35 units), which we established in previous studies. Express gastro-pH monitoring was performed for all patients before daily gastro-pH monitoring. The patients were divided into two groups: 55 patients in whom the indicators of express gastro-pH monitoring were less than the suggested ones (group I) and 28 patients in whom the indicators of express gastro-pH monitoring corresponded to the proposed criteria (group II). Both groups were comparable in terms of age, sex, height, body weight, and prescribed PPI, which allowed a comparative assessment between groups. We studied indicators of intragastric pH (X pH, Me pH, and Mo pH) of daily gastro-pH monitoring for the following time periods: 1 Basal period - time from the start of daily gastro-pH monitoring to the reception of the first PPI dose (1 hour); 2. Time after taking the first PPI dose until the end of monitoring (23 h); 3. Night time period (22:00 - 07:00). Results: Аnalyzing intragastric pH indicators during the basal period, it was found that in patients of the I group, the indicators of X pH, Me pH and Mo pH were significantly lower (p˂0.01) than in patients of the II group and, accordingly, were (1.9±0.09 , 1.75±0.07, 1.68±0.07 vs. 2.2±0.09, 2.03±0.1, 1.96±0.1). 23 hours after taking the first dose of PPI in patients of group I, the indicators of intragastric pH were significantly lower (p˂0.01) than in patients of group II and were, respectively, (4.2±0.2, 4.07±0.2 , 3.6±0.2 vs. 4.9±0.2, 4.9±0.3, 4.5±0.3). Similar results were obtained by us during the analysis of the night time period. It was established that in the I group, the indicators of intragastric pH during the night time period were significantly lower (p˂0.01) than in the patients of the II group and, accordingly, were (4.3±0.2, 4.2±0.3, 3, 9±0.3 vs. 5.03±0.2, 5.02±0.3, 4.9±0.4). Conclusions: 1. Basal gastric acidity affects the effectiveness of the acid-blocking action of PPIs on the first day of treatment both during the 23-hour period and during the night period. 2. The proposed criteria of express gastro-pH monitoring for prognostic assessment of the acid-blocking effect of PPIs before the start of treatment are sufficient.