Control of intra-oesophageal and intra-gastric pH with proton pump inhibitors in patients with Barrett's oesophagus.
BACKGROUND
A significant percentage of patients with Barrett's oesophagus (BE) will continue to manifest abnormal intra-oesophageal pH profiles regardless of proton pump inhibitor (PPI) therapy.


OBJECTIVE
We conducted a prospective study in order to determine whether a change in PPI therapy would alter intra-oesophageal and intra-gastric acid suppression in BE patients.


METHODS
Seventeen Helicobacter pylori-negative BE patients (16 males, 1 female; mean+/-S.D. age, 63.5+/-13.2).


METHODS
Twenty-four-hour pH monitoring was performed on omeprazole or lansoprazole, followed by repeat pH monitoring on rabeprazole at a dose titrated for symptom relief. Patients completed validated symptom and health-related quality-of-life (HRQL) surveys while on and off therapy.


RESULTS
Ten (59%) of the 17 patients had abnormal baseline intra-oesophageal pH profiles. Oesophageal pH monitoring values on rabeprazole were abnormal in five out of five (100%) of the omeprazole cohort and three out of five (60%) of the lansoprazole cohort that had abnormal pH profiles on initial testing. Intra-gastric pH control was inadequate in BE patients on all PPIs; the mean percentage time with intra-gastric pH below 4.0 was 46% on omeprazole, 71% on lansoprazole and 51% on rabeprazole (p=0.25). All of the patients demonstrated the phenomenon of nocturnal acid breakthrough while undergoing PPI therapy.


CONCLUSIONS
Change in PPI therapy did not alter intra-oesophageal or intra-gastric control in patients with BE.
Gerson
L B
LB
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305-5202, USA. lgerson@stanford.edu
Shetler
K
K
Triadafilopoulos
G
G
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000368:Aged; D001471:Barrett Esophagus / Q000188:drug therapy*; D001562:Benzimidazoles / Q000627:therapeutic use; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000737:chemistry / Q000473:pathology; D005260:Female; D005744:Gastric Acid / Q000737:chemistry; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives / Q000627:therapeutic use; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D006180:Proton-Translocating ATPases / Q000037:antagonists & inhibitors; D011788:Quality of Life; D064750:Rabeprazole; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D001562:Benzimidazoles; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D064750:Rabeprazole; D006180:Proton-Translocating ATPases; D009853:Omeprazole