Even though the introduction of PPIs as a therapy for acid-related disease combined with H. pylori eradication has drastically altered clinical outcomes, there are still areas where these drugs are less than optimal. For example, the short half-life of the PPIs and the need for stimulated acid secretion for maximal efficacy results in a continued fall in intragastric pH in the night. If the pH falls to below 3.0 and there is reflux, nocturnal GERD will result. Newer PPIs such as tenatoprazole or ilaprazole, because of their longer half-life, might reduce the incidence of nocturnal GERD; treatment with a PPI in the morning and a H2 receptor antagonist at night might also be beneficial.43 The complexity of H. pylori eradication treatment results in a loss of compliance, and is also difficult to administer in developing countries, where the incidence of infection can reach as high as 90%. A specific and simple monotherapy would be truly beneficial. A question that arises is also the treatment of choice for severe reflux disease in the young. Should they be placed on life-long PPIs or undergo laparoscopic fundoplication? There are advocates of both approaches.
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