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Increased acid and bile reflux in Barrett's esophagus compared to reflux esophagitis, and effect of proton pump inhibitor therapy.

Abstract

OBJECTIVES

Barrett's metaplasia is an acquired condition resulting from longstanding gastroesophageal reflux disease. Approximately 10% of esophagitis patients develop Barrett's esophagus. There is increasing evidence that duodenogastroesophageal reflux plays a role in the progression of disease. We further analyzed the correlation of acid and biliary reflux with reflux esophagitis and Barrett's esophagus and tested the effects of proton pump inhibitor therapy.

METHODS

Patients with either reflux esophagitis (group 1) or Barrett's esophagus (group 2) prospectively underwent simultaneous 24-h esophageal pH and bile reflux testing without any therapy affecting acid secretion or GI motility. A total of 16 patients in group 1 and 18 patients in group 2 were tested again under proton pump inhibitor therapy.

RESULTS

Acid and bile exposure were significantly increased in Barrett's patients (n = 23) compared to 20 esophagitis patients (median percentage of time that pH was <4 was 24.6% vs 12.4%, p = 0.01, median percentage of time that bilirubin absorbance was >0.2 was 34.7% vs 12.8%, p < 0.05). During therapy, both acid and bile reflux decreased significantly in both groups. Median percentage of time that pH was <4 and bilirubin absorbance was >0.2 before and during therapy was 18.2%/2.3% and 29.8%/0.7% (p = 0.001 and p = 0.001) in Barrett's esophagus patients versus 14.5%/3.6% and 21.5%/0.9% (p = 0.002 and p = 0.011) in esophagitis patients. There was no significant difference between the groups. In two esophagitis patients, bile reflux increased during therapy.

CONCLUSIONS

There is a good correlation of the duration of esophageal exposure to acid and bile with the severity of pathological change in the esophagus. Both acid and bile reflux is significantly suppressed by proton pump inhibitor therapy with exceptions among individual esophagitis patients. The prolonged simultaneous attack of bile and acid may play a key role in the development of Barrett's metaplasia.

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  • Authors+Show Affiliations

    ,

    Department of Medicine II, University of the Saarland, Homburg/Saar, Germany.

    ,

    Source

    MeSH

    2-Pyridinylmethylsulfinylbenzimidazoles
    Barrett Esophagus
    Benzimidazoles
    Bile Reflux
    Case-Control Studies
    Enzyme Inhibitors
    Esophagitis, Peptic
    Female
    Gastric Acid
    Humans
    Hydrogen-Ion Concentration
    Male
    Middle Aged
    Monitoring, Physiologic
    Omeprazole
    Pantoprazole
    Prospective Studies
    Proton Pump Inhibitors
    Sulfoxides

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    11232672

    Citation

    Menges, M, et al. "Increased Acid and Bile Reflux in Barrett's Esophagus Compared to Reflux Esophagitis, and Effect of Proton Pump Inhibitor Therapy." The American Journal of Gastroenterology, vol. 96, no. 2, 2001, pp. 331-7.
    Menges M, Müller M, Zeitz M. Increased acid and bile reflux in Barrett's esophagus compared to reflux esophagitis, and effect of proton pump inhibitor therapy. Am J Gastroenterol. 2001;96(2):331-7.
    Menges, M., Müller, M., & Zeitz, M. (2001). Increased acid and bile reflux in Barrett's esophagus compared to reflux esophagitis, and effect of proton pump inhibitor therapy. The American Journal of Gastroenterology, 96(2), pp. 331-7.
    Menges M, Müller M, Zeitz M. Increased Acid and Bile Reflux in Barrett's Esophagus Compared to Reflux Esophagitis, and Effect of Proton Pump Inhibitor Therapy. Am J Gastroenterol. 2001;96(2):331-7. PubMed PMID: 11232672.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Increased acid and bile reflux in Barrett's esophagus compared to reflux esophagitis, and effect of proton pump inhibitor therapy. AU - Menges,M, AU - Müller,M, AU - Zeitz,M, PY - 2001/3/10/pubmed PY - 2001/4/3/medline PY - 2001/3/10/entrez SP - 331 EP - 7 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 96 IS - 2 N2 - OBJECTIVES: Barrett's metaplasia is an acquired condition resulting from longstanding gastroesophageal reflux disease. Approximately 10% of esophagitis patients develop Barrett's esophagus. There is increasing evidence that duodenogastroesophageal reflux plays a role in the progression of disease. We further analyzed the correlation of acid and biliary reflux with reflux esophagitis and Barrett's esophagus and tested the effects of proton pump inhibitor therapy. METHODS: Patients with either reflux esophagitis (group 1) or Barrett's esophagus (group 2) prospectively underwent simultaneous 24-h esophageal pH and bile reflux testing without any therapy affecting acid secretion or GI motility. A total of 16 patients in group 1 and 18 patients in group 2 were tested again under proton pump inhibitor therapy. RESULTS: Acid and bile exposure were significantly increased in Barrett's patients (n = 23) compared to 20 esophagitis patients (median percentage of time that pH was <4 was 24.6% vs 12.4%, p = 0.01, median percentage of time that bilirubin absorbance was >0.2 was 34.7% vs 12.8%, p < 0.05). During therapy, both acid and bile reflux decreased significantly in both groups. Median percentage of time that pH was <4 and bilirubin absorbance was >0.2 before and during therapy was 18.2%/2.3% and 29.8%/0.7% (p = 0.001 and p = 0.001) in Barrett's esophagus patients versus 14.5%/3.6% and 21.5%/0.9% (p = 0.002 and p = 0.011) in esophagitis patients. There was no significant difference between the groups. In two esophagitis patients, bile reflux increased during therapy. CONCLUSIONS: There is a good correlation of the duration of esophageal exposure to acid and bile with the severity of pathological change in the esophagus. Both acid and bile reflux is significantly suppressed by proton pump inhibitor therapy with exceptions among individual esophagitis patients. The prolonged simultaneous attack of bile and acid may play a key role in the development of Barrett's metaplasia. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/11232672/Increased_acid_and_bile_reflux_in_Barrett's_esophagus_compared_to_reflux_esophagitis_and_effect_of_proton_pump_inhibitor_therapy_ L2 - http://Insights.ovid.com/pubmed?pmid=11232672 DB - PRIME DP - Unbound Medicine ER -