The study authors analyzed intragastric 24-hour pH profiles in a series of 45 patients treated with PPIs twice daily and identified that it occurred in 70% of patients during the nighttime period. Peghini and colleagues were the first to introduce the term "nocturnal acid breakthrough," and defined it as gastric acid recovery to a pH level < 4 for at least 60 consecutive minutes in the overnight period (10:00 PM to 6:00 AM). Recovery of intragastric acidity, primarily during nighttime while on PPI therapy, should not be regarded as a failure of, or resistance to, these compounds, but rather as an expected phenomenon that may require attention in some patients. Reasons for this phenomenon include the relative short serum half-life of PPIs (2-4 hours), the fact that not all proton pumps are active at the same time, and that generation of new proton pumps is a continuous process. Subsequent clinical data revealed that PPIs, even though they significantly decrease acid secretion, do not completely eliminate intragastric acidity. The concern about iatrogenic achlorhydria and its consequences led to an initial "black box" warning regarding the duration of treatment with PPIs. The initial, basic science reports on the PPIs described these medications as irreversible inhibitors of the proton pump, underscoring the need for synthesis of new proton pumps before acid secretion could be resumed. The introduction of PPIs in the 1980s changed the clinical approach to and management of peptic diseases such as gastric ulcers, duodenal ulcers, and GERD. The H+/K+ ATP-ase responsible for this process is also known as the "proton pump," and is inhibited by substituted benzimidazoles or PPIs. The energy required to transfer protons across the high concentration gradient (intracellular pH is approximately 7 while the intragastric pH is close to 1) comes from cleaving ATP molecules. (16) The spider is solitary and nocturnal and will bite only as a last resort, but people who are hypersensitive to the venom may be at risk.The final step in gastric acid secretion is the exchange of intracellular protons (H+) for extracellular potassium (K+). (15) Being naturally nocturnal and excellent at hiding, they're all able to keep a low profile. (14) Max has the night beat, circling a nocturnal but always active Los Angeles. (13) The second reason for the interest in owls is that they are beautiful to look at and most of them are nocturnal which means that they hunt at night. (12) She even attempted a little nocturnal grave robbery in order to unearth the final proof from Shakespeare's tomb.
(11) She was reasonably nocturnal and could stay awake all night when really necessary. (10) She and her kind are shy, nocturnal animals, usually hiding deep in burrows and rarely seen in the wild. (9) They are nocturnal hunters and feed mainly on small mammals like mice, rats, voles and shrews. (8) Owl boxes have been put up around the site to attract the nocturnal predators and there are plans for more bird boxes as the trees flourish. (7) Now sleeping is one of my favourite hobbies, so you can imagine the state I'm in after all this nocturnal wrestling. (6) I've seen a few city foxes during my nocturnal walks around Birmingham and always mistake them for big cats or small dogs.
(5) Saved from his crazy nocturnal adventure, he sets about building a microlight aircraft shaped like a dragonfly. (4) Once a diurnal mammal, the dugong is now nocturnal as it forages for food. (3) Visitor night tours to view these nocturnal creatures have also been sketched in for the future. (2) No because I'm nocturnal and by the time my ears are awake enough to listen to music everyone else is asleep. (1) Worse, his landlady was taking a nocturnal interest in his activities.
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