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Persistent acid reflux and symptoms in patients with Barrett's oesophagus on proton-pump inhibitor therapy.
Eur J Gastroenterol Hepatol. 2002 Nov; 14(11):1187-92.EJ

Abstract

OBJECTIVES

To assess both acid gastro-oesophageal reflux (GOR) suppression in patients with Barrett's oesophagus on proton-pump inhibitors (PPI) and the predictive value of symptoms. DESIGN A prospective study of patients with Barrett's epithelium (> 3 cm, containing specialized intestinal metaplasia).

PATIENTS AND METHODS

Forty-five patients with Barrett's epithelium were recruited. Therapy was adjusted to omeprazole 20 mg twice daily. Oesophageal manometry and 24 h pH studies were performed on treatment. Heartburn score was calculated before and after PPI dose adjustment. In patients with persisting acid reflux, omeprazole dose was increased to 20 mg three times daily and pH studies repeated. Adequacy of GOR suppression, assessed by pH monitoring, was related to heartburn score (0-3).

RESULTS

Twenty of the 45 patients were symptomatic (mean score 1.9) on pre-study treatment (mainly omeprazole < 20 mg once daily); on omeprazole 20 mg twice daily, only six patients remained symptomatic (mean score 1.6). Ten patients (22%) had persisting GOR on omeprazole 20 mg twice daily (median % total time with pH < 4 was 8%). Abnormal nocturnal reflux was found in nine and abnormal daytime reflux in only four patients. Heartburn persisted in three of these 10 patients (30%). Those remaining symptomatic had more daytime acid reflux than the asymptomatic patients with persistent reflux (median percentage daytime at pH < 4 was 13.6% vs 0.6%, respectively; P < 0.01). By increasing the omeprazole dose to 20 mg three times daily, only three of the 10 had persistent acid reflux.

CONCLUSIONS

Persistent acid reflux on PPI therapy is common in patients with Barrett's oesophagus. Although nocturnal acid reflux is the most common finding, symptoms tended to occur in those with abnormal daytime reflux. Symptom resolution does not guarantee acid reflux control.

Authors+Show Affiliations

Department of Gastroenterology, University Hospitals of Leicester NHS Trust, UK.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12439112

Citation

Basu, Kumar K., et al. "Persistent Acid Reflux and Symptoms in Patients With Barrett's Oesophagus On Proton-pump Inhibitor Therapy." European Journal of Gastroenterology & Hepatology, vol. 14, no. 11, 2002, pp. 1187-92.
Basu KK, Bale R, West KP, et al. Persistent acid reflux and symptoms in patients with Barrett's oesophagus on proton-pump inhibitor therapy. Eur J Gastroenterol Hepatol. 2002;14(11):1187-92.
Basu, K. K., Bale, R., West, K. P., & de Caestecker, J. S. (2002). Persistent acid reflux and symptoms in patients with Barrett's oesophagus on proton-pump inhibitor therapy. European Journal of Gastroenterology & Hepatology, 14(11), 1187-92.
Basu KK, et al. Persistent Acid Reflux and Symptoms in Patients With Barrett's Oesophagus On Proton-pump Inhibitor Therapy. Eur J Gastroenterol Hepatol. 2002;14(11):1187-92. PubMed PMID: 12439112.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Persistent acid reflux and symptoms in patients with Barrett's oesophagus on proton-pump inhibitor therapy. AU - Basu,Kumar K, AU - Bale,Robert, AU - West,Kevin P, AU - de Caestecker,John S, PY - 2002/11/20/pubmed PY - 2003/4/4/medline PY - 2002/11/20/entrez SP - 1187 EP - 92 JF - European journal of gastroenterology & hepatology JO - Eur J Gastroenterol Hepatol VL - 14 IS - 11 N2 - OBJECTIVES: To assess both acid gastro-oesophageal reflux (GOR) suppression in patients with Barrett's oesophagus on proton-pump inhibitors (PPI) and the predictive value of symptoms. DESIGN A prospective study of patients with Barrett's epithelium (> 3 cm, containing specialized intestinal metaplasia). PATIENTS AND METHODS: Forty-five patients with Barrett's epithelium were recruited. Therapy was adjusted to omeprazole 20 mg twice daily. Oesophageal manometry and 24 h pH studies were performed on treatment. Heartburn score was calculated before and after PPI dose adjustment. In patients with persisting acid reflux, omeprazole dose was increased to 20 mg three times daily and pH studies repeated. Adequacy of GOR suppression, assessed by pH monitoring, was related to heartburn score (0-3). RESULTS: Twenty of the 45 patients were symptomatic (mean score 1.9) on pre-study treatment (mainly omeprazole < 20 mg once daily); on omeprazole 20 mg twice daily, only six patients remained symptomatic (mean score 1.6). Ten patients (22%) had persisting GOR on omeprazole 20 mg twice daily (median % total time with pH < 4 was 8%). Abnormal nocturnal reflux was found in nine and abnormal daytime reflux in only four patients. Heartburn persisted in three of these 10 patients (30%). Those remaining symptomatic had more daytime acid reflux than the asymptomatic patients with persistent reflux (median percentage daytime at pH < 4 was 13.6% vs 0.6%, respectively; P < 0.01). By increasing the omeprazole dose to 20 mg three times daily, only three of the 10 had persistent acid reflux. CONCLUSIONS: Persistent acid reflux on PPI therapy is common in patients with Barrett's oesophagus. Although nocturnal acid reflux is the most common finding, symptoms tended to occur in those with abnormal daytime reflux. Symptom resolution does not guarantee acid reflux control. SN - 0954-691X UR - https://www.unboundmedicine.com/medline/citation/12439112/Persistent_acid_reflux_and_symptoms_in_patients_with_Barrett's_oesophagus_on_proton_pump_inhibitor_therapy_ L2 - http://dx.doi.org/10.1097/00042737-200211000-00005 DB - PRIME DP - Unbound Medicine ER -