Importance of pH control in the management of GERD

The degree of esophageal mucosal injury that occurs in patients with gastro esophageal reflux disease depends on duration of exposure and pH of the ref luxate. Evidence suggests that an intraesophageal pH of less than 4.0 direc tly correlates with the degree of mucosal injury. The advent of acid secret ory inhibitors such as the histamine(2)-receptor antagonists (H2RAs) and, m ore recently, the proton pump inhibitors (PPIs) has revolutionized the trea tment of patients with reflux disease. However, the evidence linking the de gree of mucosal damage to PH of the refluxate has prompted investigators to reevaluate the effectiveness of these agents. The PPIs are significantly m ore effective than the H2RAs in achieving and sustaining an intragastric pH above 4.0. The results of clinical trials performed with the PPIs indicate a faster rate of healing of erosive esophagitis and of symptom relief than treatment with H2RAs.