Once-Daily Omeprazole/Sodium Bicarbonate Heals Severe Refractory Reflux Esophagitis with Morning or Nighttime Dosing

Diana M. Orbelo, Felicity T. Enders, Yvonne Romero, Dawn L. Francis, Sami R. Achem, Tushar S. Dabade, Michael D. Crowell, Debra M. Geno, Ramona S. DeJesus, Vikneswaran Namasivayam, Steven C. Adamson, Amindra S. Arora, Andrew J. Majka, Jeffrey A. Alexander, Joseph A. Murray, Matthew Lohse, Nancy N. Diehl, Mary Fredericksen, Kee Wook Jung, Margaret S. HoustonAngela E. O’Neil, David A. Katzka

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Morning dose or twice-daily proton pump inhibitor (PPI) use is often prescribed to heal severe reflux esophagitis.

Aim: Compare the effect of single dose morning (control arm) versus nighttime (experimental arm) omeprazole/sodium bicarbonate (Zegerid®) (IR-OME) on esophagitis and gastroesophageal reflux symptoms.

Conclusions: Once-daily IR-OME (taken morning or night) effectively heals severe reflux esophagitis and improves GERD symptoms. Results support the clinical practice recommendation to repeat EGD after 8 weeks PPI therapy in severe esophagitis patients to assure healing and exclude Barrett’s esophagus.

Methods: Adult outpatients with Los Angeles grade C or D esophagitis were allocated to open-label 40 mg IR-OME once a day for 8 weeks in a prospective, randomized, parallel design, single center study. Esophagogastroduodenoscopy (EGD) and validated self-report symptom questionnaires were completed at baseline and follow-up. Intention-to-treat and per-protocol analyses were performed.

Results: Ninety-two of 128 (72 %) eligible subjects participated [64 (70 %) male, mean age 58 (range 19–86), median BMI 29 (range 21–51), 58 C:34 D]. Overall, 81 (88 %) subjects healed [n = 70 (76 %)] or improved [n = 11 (12 %)] erosions. There was no significant difference (morning vs. night) in mucosal healing [81 vs. 71 %, (p = 0.44)] or symptom resolution [heartburn (77 vs. 65 %, p = 0.12), acid regurgitation (82 vs. 73 %, p = 0.28)]. Prevalence of newly identified Barrett’s esophagus was 14 % with half diagnosed only after treatment.

Original languageEnglish (US)
Pages (from-to)146-162
Number of pages17
JournalDigestive diseases and sciences
Issue number1
StatePublished - Jan 2014


  • Barrett’s esophagus
  • Esophagitis
  • Gastroesophageal reflux disease
  • Prospective randomized controlled trial

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology


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