Barrett's esophagus is a metaplastic condition associated with
gastroesophageal reflux disease and an increased risk for
adenocarcinoma.
Acid plays a significant role in the development and progression of
Barrett's esophagus and high dose
proton pump inhibitor (PPI)
therapy is often needed. The aim of this study is to assess the efficacy of
esomeprazole, a new potent PPI, on symptom relief and intraesophageal and intragastric
acid suppression in patients with
Barrett's esophagus (BE). Patients were evaluated by standardized questionnaires and dual sensor 24-h pH monitoring while receiving
esomeprazole at a dose (40-80 mg/day) needed for control of symptoms. Analyses of intraesophageal and intragastric pH profiles were then made. Thirteen patients, mostly men, were studied. All tolerated
esomeprazole (40-80 mg/day) with good symptom control. Sixty-two percent of patients with BE had abnormal intraesophageal pH profiles despite adequate symptom control on
esomeprazole which was associated with significant breakthrough of intraesophageal
acid control, particularly at night. Low nocturnal intragastric pH correlated highly with nocturnal intraesophageal
acid reflux (P = 0.004) and there was a relative failure of nocturnal intragastric
acid control with
esomeprazole. A high percentage of patients with BE continue to exhibit pathologic
GERD and low intragastric pH despite
esomeprazole for reflux symptom control. For an antisecretory treatment aimed at
chemoprevention of esophageal
adenocarcinoma to be effective, higher PPI dosing confirmed by pH monitoring may be necessary.