Transepithelial leak in Barrett's esophagus patients: the role of proton pump inhibitors.
OBJECTIVE
To determine if the observed paracellular sucrose leak in Barrett's esophagus patients is due to their proton pump inhibitor (PPI) use.


METHODS
The in vivo sucrose permeability test was administered to healthy controls, to Barrett's patients and to non-Barrett's patients on continuous PPI therapy. Degree of leak was tested for correlation with presence of Barrett's, use of PPIs, and length of Barrett's segment and duration of PPI use.


RESULTS
Barrett's patients manifested a near 3-fold greater, upper gastrointestinal sucrose leak than healthy controls. A decrease of sucrose leak was observed in Barrett's patients who ceased PPI use for 7 d. Although initial introduction of PPI use (in a PPI-naïve population) results in dramatic increase in sucrose leak, long-term, continuous PPI use manifested a slow spontaneous decline in leak. The sucrose leak observed in Barrett's patients showed no correlation to the amount of Barrett's tissue present in the esophagus.


CONCLUSIONS
Although future research is needed to determine the degree of paracellular leak in actual Barrett's mucosa, the relatively high degree of leak observed with in vivo sucrose permeability measurement of Barrett's patients reflects their PPI use and not their Barrett's tissue per se.
Division of Gastroenterology, Lankenau Hospital, Wynnewood, PA 19096, United States.
Christopher
C
Farrell
Melissa
M
Morgan
Owen
O
Tully
Kevin
K
Wolov
Keith
K
Kearney
Benjamin
B
Ngo
Giancarlo
G
Mercogliano
James J
JJ
Thornton
Mary Carmen
MC
Valenzano
James M
JM
Mullin
D001471:Barrett Esophagus / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D016022:Case-Control Studies; D004847:Epithelial Cells / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D004947:Esophagus / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008679:Metaplasia; D010539:Permeability; D015143:Philadelphia; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013395:Sucrose; D013997:Time Factors
D054328:Proton Pump Inhibitors; D013395:Sucrose