To evaluate long-term medical
therapy in patients with
Barrett's esophagus, six patients were studied before and after long-term
therapy with
cimetidine for a mean period of 11.7 months. Some patients also received
bethanechol. All had severe symptoms of
gastroesophageal reflux resistant to intensive
antacid therapy, specialized columnar epithelium by biopsy, and endoscopic evidence of severe
inflammation. Esophageal manometry documented a hypotensive lower esophageal sphincter in three patients and low peristaltic amplitude in the distal esophagus in four. Treatment was begun with
cimetidine, 300 mg orally four times daily. If symptoms did not totally abate,
bethanechol, 25 mg orally four times daily, was added.
Cimetidine completely relieved or dramatically reduced symptoms in all patients. Adding
bethanechol produced further symptomatic improvement in three of four patients. After initial dilatation in the two patients with
strictures, there was no recurrence. Endoscopic evidence of
inflammation resolved completely in four patients and was markedly improved in two. Treatment with both drugs was well tolerated by all patients. The abnormally placed squamo-columnar junction did not regress during follow-up.