Normalization of esophageal pH with high-dose proton pump inhibitor therapy does not result in regression of Barrett's esophagus.
OBJECTIVE
The importance of esophageal acid control in the management of Barrett's esophagus is controversial. The objective of this study was to assess the impact of esophageal acid control on the symptoms of reflux disease, healing of erosive esophagitis, change in length of Barrett's epithelium, and the appearance of squamous islands.


METHODS
Thirteen of 27 patients on 60 mg lansoprazole underwent ambulatory 24 h esophageal pH monitoring while on therapy. Symptoms were recorded, and the length of Barrett's epithelium was measured, photographed, and biopsied every 6 months over an average of 5.7 yr.


RESULTS
Eight of 13 patients had a normal 24 h pH (group I, mean pH < 4, 0.8%), five patients had abnormal results (group II, mean pH < 4, 10.6%). Symptoms improved in all patients, and there was complete healing of erosive esophagitis in all patients. An increase in the number of squamous islands was noted in 62.5% of patients in group I and in 80% of patients in group II. The mean length of Barrett's epithelium at baseline and study completion in group I was 5.6 and 5.0 cm, respectively (mean decrease, 0.6 cm), and for group II was 4.2 and 4.2 cm, respectively (mean decrease, 0 cm). There was no significant difference in the change in length between the two groups (p = 0.494).


CONCLUSIONS
Although symptoms improved, erosive esophagitis healed, and squamous islands increased, there was no significant decrease in the length of Barrett's esophagus. Control of esophageal pH alone is not sufficient for the reversal of Barrett's esophagus.
Sharma
P
P
Gastroenterology Section, University of Arizona Health Sciences Center and VA Medical Center, Tucson 85723, USA.
Sampliner
R E
RE
Camargo
E
E
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D001706:Biopsy; D004305:Dose-Response Relationship, Drug; D004945:Esophagoscopy; D004947:Esophagus / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D006863:Hydrogen-Ion Concentration; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000031:analogs & derivatives*; D054328:Proton Pump Inhibitors; D012074:Remission Induction
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D009853:Omeprazole