Laryngopharyngeal reflux disease with nocturnal gastric acid breakthrough while on proton pump inhibitor therapy.

Laryngopharyngeal reflux disease (LPRD) with nocturnal recovery of gastric acid secretion (nocturnal acid breakthrough: NAB) with proton pump inhibitors (PPI) was first reported. A 79-year-old Japanese woman complained of globus pharyngeus and mild heartburn was examined with the use of tetra-probe 24-h pH monitoring. She had been treated for reflux esophagitis (GERD) for 12 months prior to her visit to our office. She took Lansoprazole (30 mg/day) before dinner every day. The tetra-probe 24-h pH monitoring revealed that the recovery of gastric acid secretion occurred 6.5 h after taking the dose of PPI. The intragastric pH dropped < 4 at about 23:00 and remained below that level for 4 h and 50 min. The 24-h pH-metry at each probe showed that the nocturnal recovery of gastric acid secretion with PPI (NAB on PPI) influenced gastroesophageal and laryngopharyngeal refluxes. The symptoms of the pharynx and esophagus disappeared after taking H2 receptor antagonist (H2RA) additionally before bedtime.