Proton pump inhibitor influence on reflux in Barrett's oesophagus.
OBJECTIVE
It is important to identify factors responsible for the development of Barrett's oesophagus (BO). The effect of proton pump inhibitors (PPIs) on oesophageal clearance of both acid and alkaline reflux in these patients is uncertain and studies comparing BO patients and healthy controls (HCs) have not been performed earlier.


METHODS
Two groups of patients were studied: 18 HCs and 12 BO patients. Oesophageal motility, acid reflux and duodenogastro-oesophageal reflux (DGOR) were measured using a three-pressure transducer catheter with an antimony pH tip, connected to a sodium ion selective electrode. All patients were studied both on and off PPIs.


RESULTS
Without PPI therapy, BO patients had significantly more upright and supine acid reflux and upright DGOR compared with HCs. During acid reflux, HC demonstrated more peristalsis than BO [HC, % peristalsis=64 (9), BO=53 (8), P<0.01], but this was not seen during DGOR. [HC, % peristalsis=68 (14), BO=56 (11)]. In Barrett's patients, DGOR was significantly reduced with PPIs [off PPI, % upright DGOR=61 (17), on PPIs=19 (15), P<0.01], and no oesophageal motility differences were seen compared with results without PPIs.


CONCLUSIONS
HCs demonstrate better oesophageal motility compared with BO patients to prevent acid and alkaline reflux. When acid reflux occurred, HCs had better coordinated motility to remove it. This increased coordination did not occur during DGOR, suggesting different stimulation mechanisms. PPI reduced DGOR in BO patients, without any change in oesophageal motility.
Smythe
Anne
A
Surgical Unit, Royal Hallamshire Hospital, Sheffield, England. A.Smythe@sheffield.ac.uk
Troy
Gill P
GP
Ackroyd
Roger
R
Bird
Nigel C
NC
D000328:Adult; D001471:Barrett Esophagus / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D004383:Duodenogastric Reflux / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D050782:Esophageal pH Monitoring; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D010528:Peristalsis / Q000187:drug effects; D011187:Posture; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D055815:Young Adult
D054328:Proton Pump Inhibitors