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Complete elimination of reflux symptoms does not guarantee normalization of intraesophageal acid reflux in patients with Barrett's esophagus.
Am J Gastroenterol. 1998 May; 93(5):711-6.AJ

Abstract

OBJECTIVE

Normalization of intraesophageal acid exposure is increasingly recognized as a desired goal in the management of Barrett's esophagus. In this prospective trial, we studied patients with Barrett's esophagus by 24-h intraesophageal pH monitoring after having completely eliminated their reflux symptoms with lansoprazole, to determine whether they had achieved normalization of intraesophageal pH.

METHODS

Thirty patients with Barrett's esophagus, all of whom had presented with reflux symptoms, were treated with lansoprazole (15-30 mg/day) until they were asymptomatic. Twenty-four-hour ambulatory pH monitoring was performed while they were receiving lansoprazole and were asymptomatic.

RESULTS

Twelve patients (40%) showed persistent bipositional, pathologic acid reflux while on therapy, with a mean DeMeester score of 52.8 (95% CI: 33.8-71.8); the remaining 18 (60%) exhibited normalization of intraesophageal acid exposure with a score of 4.4 (95% CI: 2.3-6.6,p < 0.001). This inadequate control of intraesophageal pH is most likely due to incomplete gastric acid suppression induced by the drug and is associated with a variable acid (distal > proximal) exposure within the esophagus. The two groups were not different in regard to their symptom frequency and severity before therapy, amount of lansoprazole dosage required to eliminate symptoms, length of Barrett's metaplasia, presence of hiatal hernia, lower esophageal sphincter resting tone and length, or esophageal peristaltic function.

CONCLUSION

Complete symptom eradication with lansoprazole (15-30 mg daily) in patients with Barrett's esophagus does not guarantee normalization of intraesophageal pH profile. If the goal of therapy in such patients is to achieve complete intraesophageal acid suppression, 24-h ambulatory esophageal pH monitoring should be performed to titrate therapy.

Authors+Show Affiliations

Gastroenterology Section, Palo Alto Veterans Affairs Health Care System, California 94304, USA.No affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

9625114

Citation

Ouatu-Lascar, R, and G Triadafilopoulos. "Complete Elimination of Reflux Symptoms Does Not Guarantee Normalization of Intraesophageal Acid Reflux in Patients With Barrett's Esophagus." The American Journal of Gastroenterology, vol. 93, no. 5, 1998, pp. 711-6.
Ouatu-Lascar R, Triadafilopoulos G. Complete elimination of reflux symptoms does not guarantee normalization of intraesophageal acid reflux in patients with Barrett's esophagus. Am J Gastroenterol. 1998;93(5):711-6.
Ouatu-Lascar, R., & Triadafilopoulos, G. (1998). Complete elimination of reflux symptoms does not guarantee normalization of intraesophageal acid reflux in patients with Barrett's esophagus. The American Journal of Gastroenterology, 93(5), 711-6.
Ouatu-Lascar R, Triadafilopoulos G. Complete Elimination of Reflux Symptoms Does Not Guarantee Normalization of Intraesophageal Acid Reflux in Patients With Barrett's Esophagus. Am J Gastroenterol. 1998;93(5):711-6. PubMed PMID: 9625114.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Complete elimination of reflux symptoms does not guarantee normalization of intraesophageal acid reflux in patients with Barrett's esophagus. AU - Ouatu-Lascar,R, AU - Triadafilopoulos,G, PY - 1998/6/13/pubmed PY - 1998/6/13/medline PY - 1998/6/13/entrez SP - 711 EP - 6 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 93 IS - 5 N2 - OBJECTIVE: Normalization of intraesophageal acid exposure is increasingly recognized as a desired goal in the management of Barrett's esophagus. In this prospective trial, we studied patients with Barrett's esophagus by 24-h intraesophageal pH monitoring after having completely eliminated their reflux symptoms with lansoprazole, to determine whether they had achieved normalization of intraesophageal pH. METHODS: Thirty patients with Barrett's esophagus, all of whom had presented with reflux symptoms, were treated with lansoprazole (15-30 mg/day) until they were asymptomatic. Twenty-four-hour ambulatory pH monitoring was performed while they were receiving lansoprazole and were asymptomatic. RESULTS: Twelve patients (40%) showed persistent bipositional, pathologic acid reflux while on therapy, with a mean DeMeester score of 52.8 (95% CI: 33.8-71.8); the remaining 18 (60%) exhibited normalization of intraesophageal acid exposure with a score of 4.4 (95% CI: 2.3-6.6,p < 0.001). This inadequate control of intraesophageal pH is most likely due to incomplete gastric acid suppression induced by the drug and is associated with a variable acid (distal > proximal) exposure within the esophagus. The two groups were not different in regard to their symptom frequency and severity before therapy, amount of lansoprazole dosage required to eliminate symptoms, length of Barrett's metaplasia, presence of hiatal hernia, lower esophageal sphincter resting tone and length, or esophageal peristaltic function. CONCLUSION: Complete symptom eradication with lansoprazole (15-30 mg daily) in patients with Barrett's esophagus does not guarantee normalization of intraesophageal pH profile. If the goal of therapy in such patients is to achieve complete intraesophageal acid suppression, 24-h ambulatory esophageal pH monitoring should be performed to titrate therapy. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/9625114/Complete_elimination_of_reflux_symptoms_does_not_guarantee_normalization_of_intraesophageal_acid_reflux_in_patients_with_Barrett's_esophagus_ L2 - https://Insights.ovid.com/pubmed?pmid=9625114 DB - PRIME DP - Unbound Medicine ER -