Control of intra-oesophageal and intra-gastric pH with proton pump inhibitors in patients with Barrett's oesophagus

• Published in: Digestive and liver disease Vol. 37; no. 9; pp. 651 - 658
• Main Authors: Gerson, L.B., Shetler, K., Triadafilopoulos, G.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.09.2005
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; Aged; Ambulatory pH monitoring; Barrett Esophagus - drug therapy; Barrett's oesophagus; Benzimidazoles - therapeutic use; Esophageal pH Monitoring; Esophagus - chemistry; Esophagus - pathology; Female; Gastric Acid - chemistry; GERD; Humans; Hydrogen-Ion Concentration - drug effects; Lansoprazole; Male; Middle Aged; Omeprazole; Omeprazole - analogs & derivatives; Omeprazole - therapeutic use; Prospective Studies; Proton Pump Inhibitors; Proton-Translocating ATPases - antagonists & inhibitors; Quality of Life; Rabeprazole; Treatment Outcome; Omeprazole; GERD; Barrett's oesophagus; Proton pump inhibitors; Rabeprazole; Ambulatory pH monitoring; Lansoprazole
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2005.04.013

A significant percentage of patients with Barrett's oesophagus (BE) will continue to manifest abnormal intra-oesophageal pH profiles regardless of proton pump inhibitor (PPI) therapy. We conducted a prospective study in order to determine whether a change in PPI therapy would alter intra-oesophageal and intra-gastric acid suppression in BE patients. Seventeen Helicobacter pylori-negative BE patients (16 males, 1 female; mean ± S.D. age, 63.5 ± 13.2). Twenty-four-hour pH monitoring was performed on omeprazole or lansoprazole, followed by repeat pH monitoring on rabeprazole at a dose titrated for symptom relief. Patients completed validated symptom and health-related quality-of-life (HRQL) surveys while on and off therapy. Ten (59%) of the 17 patients had abnormal baseline intra-oesophageal pH profiles. Oesophageal pH monitoring values on rabeprazole were abnormal in five out of five (100%) of the omeprazole cohort and three out of five (60%) of the lansoprazole cohort that had abnormal pH profiles on initial testing. Intra-gastric pH control was inadequate in BE patients on all PPIs; the mean percentage time with intra-gastric pH below 4.0 was 46% on omeprazole, 71% on lansoprazole and 51% on rabeprazole ( p = 0.25). All of the patients demonstrated the phenomenon of nocturnal acid breakthrough while undergoing PPI therapy. Change in PPI therapy did not alter intra-oesophageal or intra-gastric control in patients with BE.