Nocturnal reflex: Assessing and addressing the problem
Colonography, Computed Tomographic
Nocturnal gastroesophageal reflux is a common but underappreciated clinical challenge. Although the condition can be asymptomatic, nighttime reflux symptoms can cause sleep disturbances and impact a patient's quality of life; in addition, nocturnal reflux, whether symptomatic or asymptomatic, can lead to complications such as erosive esophagitis and Barrett's esophagus. Proton pump inhibitors are the mainstay of antisecretory therapy for daytime and nighttime gastroesophageal reflux disease, but their effectiveness for achieving nocturnal pH control may be limited by pharmacologic characteristics. Some of these limitations can be overcome by careful attention to the dosing schedule or by adding a histamine H 2 -receptor antagonist at bedtime to proton pump inhibitor therapy. The recent availability of a new, immediate-release formulation of omeprazole-which provides rapid onset of action, fast control of gastric acidity, and sustained control of intragastric pH at steady state-offers intriguing possibilities for the improved management of nighttime heartburn.