Impact of esophageal acid exposure on the endoscopic reversal of Barrett's esophagus.
OBJECTIVE
Normalization of esophageal acid exposure had been assumed to be necessary for the reversal of Barrett's esophagus with endoscopic therapy. This assumption is examined by evaluating the esophageal pH in a group of patients undergoing reversal therapy with fixed high-dose proton pump inhibitor therapy and endoscopic multipolar electrocoagulation (MPEC).


METHODS
Patients with Barrett's esophagus of 2-6 cm in length were treated with omeprazole (40 mg b.i.d.). They underwent 24-h esophageal pH monitoring 5 cm above the upper margin of the lower esophageal sphincter determined by a water-perfused catheter. They then underwent MPEC therapy to an endpoint of elimination of Barrett's (reversal) by both endoscopy and biopsy 6 months after the last MPEC session or failure to achieve visual (endoscopic) reversal after six treatment sessions.


RESULTS
Twenty patients had 24-h pH testing and reached a reversal endpoint. Three patients had abnormal pH tests, two total and supine and one supine only. These patients had documented reversal. The remaining 17 patients had normal pH testing but five failed reversal therapy.


CONCLUSIONS
Barrett's esophagus can be completely reversed with endoscopic therapy despite abnormal esophageal acid exposure. Also, patients can fail reversal even with normal esophageal acid exposure. The necessary reduction of esophageal acid exposure for reversal therapy has yet to be defined.
Sampliner
Richard E
RE
Department of Internal Medicine, Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson 85723, USA.
Camargo
Lisa
L
Fass
Ronnie
R
D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D004564:Electrocoagulation / Q000379:methods*; D004791:Enzyme Inhibitors / Q000008:administration & dosage*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009853:Omeprazole / Q000008:administration & dosage*; D016896:Treatment Outcome
D004791:Enzyme Inhibitors; D009853:Omeprazole