BASAL ACID OUTPUT AND GASTRIC-ACID HYPERSECRETION IN GASTROESOPHAGEALREFLUX DISEASE - CORRELATION WITH RANITIDINE THERAPY

The purpose of this study was to evaluate possible differences in basa l gastric acid secretion with regard to severity of gastroesophageal r eflux disease. Basal acid output was determined by nasogastric suction in 228 patients with gastroesophageal reflux disease who received upp er gastrointestinal endoscopy and were diagnosed with either pyrosis a lone (N = 98), erosive esophagitis with or without pyrosis (N = 87), o r Barrett's esophagus (N = 43). Mean basal acid output for the 228 pat ients with gastroesophageal reflux disease was 6.5 +/- 5.6 meq/hr, whi ch was significantly different from 65 normal subjects with a mean bas al acid output of 3.0 +/- 2.7 meq/hr (P < 0.0001). Compared to normal subjects, mean basal acid outputs significantly differed for patients with pyrosis (P < 0.05), esophagitis (P < 0.01), and Barrett's esophag us (P < 0.01). There was also a significant difference in mean basal a cid output between the patients with pyrosis and Barrett's esophagus ( P < 0.01). Nineteen of the 98 patients with pyrosis (19%), 24 of the 8 7 patients with esophagitis (28%), and 15 of the 43 patients with Barr ett's esophagus (35%) had gastric acid hypersecretion (basal acid outp ut greater than 10.0 meq/hr). One hundred forty-six patients with gast roesophageal reflux disease were treated with ranitidine in doses that resulted in complete healing of esophagitis and disappearance of pyro sis. Ninety-three patients responded to ranitidine 300 mg/day; however , 53 patients required increased dose of ranitidine (mean 1205 mg/day, range 600-3000 mg/day). There was a significant correlation between b asal acid output and daily ranitidine dose required for therapy for th e 146 patients with gastroesophageal reflux disease (r = 0.53, P = 0.0 001). Furthermore, a significant association was also found between th e presence of gastric acid hypersecretion and the requirement for incr eased doses of ranitidine (greater than 300 mg/day) (P = 0.00001). The se results indicate that there is a subset of patients with gastroesop hageal reflux disease who do have idiopathic gastric acid hypersecreti on. Moreover these patients have an apparently higher requirement for medication dosage in order to achieve therapeutic efficacy.