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Trial by indulgence - Prophylactic use of a proton pump inhibitor before food and alcohol excesses



Trial by indulgence - Prophylactic use of a proton pump inhibitor before food and alcohol excesses



Gastroenterology. 122(4 Suppl. 1): A-201, Il



Background and Aims: On an anecdotal basis, physicians and their associates commonly consume a proton pump inhibitor to minimise symptoms likely to be provoked by gastronomical excesses such as late night food and alcohol consumption. The efficacy of this practice has not been formally studied. We performed a randomised, double-blind, placebo controlled, trial of a single dose of lanzoprazole (30rag) taken at the beginning of a night of Irish festivity. Methods: Study subjects were recruited randomly from local and hospital physicians, most of whom were known for proclivity to social and gastronomical excesses. Exclusions included: those with Barretts esophagus, stricture, peptic ulcer, or those who were pregnant or taking oral contraceptives, anticonvulsants, or antifungals. Subjects taking regular acid suppressants were asked to discontinue these for 3 weeks prior to the study. Subjects were required to avoid driving and to stay overnight at the study location. Each participant completed a baseline questionnaire on basic demographics and reflux history and a second questionnaire the following morning (n=56; 37 male, 19 female, mean age 38 yr). Approximately 90rain prior to the meal, participants were witnessed taking either placebo or 30mg lanzoprazole. The provocative meal was consumed after 9pro. It was dietetically designed, moderately spiced and comprised 40% fat, 46% carbohydrate and 14% protein. Bar tokens were dispensed to permit accurate quantification of alcohol consumption (mean=15 units). Results: Overall, 40% Of subjects reported significant reflux symptoms and there was no statistical difference in symptoms between those taking lanzoprazole vs. placebo. However, reflux was more frequent amongst those consuming>15 units of alcohol (13/26, 50%) compared with those consuming<15 units (7/30, 24%; p<0.05), and for those who consumed>15 units of alcohol, lanzoprazole was associated with a lower rate of heartburn (5/15, 33%) compared with placebo (8/11, 73%; p<0.05). Conclusion: A single dose of a proton pump inhibitor prior to food and alcohol indulgence was associated with reduced heartburn, but this was evident only for revellers consuming>15 units of alcohol. The protocol was enjoyed by all test subjects, most of whom enthusiastically volunteered for a future study powered to study the higher alcohol challenge.

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