Regression of columnar lined (Barrett's) oesophagus with continuous omeprazole therapy

• Published in: Alimentary pharmacology & therapeutics Vol. 7; no. 6; pp. 623 - 628
• Main Authors: GORE, S., HEALEY, C. J., SUTTON, R., EYRE‐BROOK, I. A., GEAR, M. W. L., SHEPHERD, N. A., WILKINSON, S. P.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.12.1993; Blackwell
• Subjects: Adult; Aged; Barrett Esophagus - drug therapy; Barrett Esophagus - pathology; Biological and medical sciences; Biopsy; Digestive system; Esophagoscopy; Esophagus - drug effects; Esophagus - pathology; Female; Humans; Male; Medical sciences; Microscopy, Electron; Middle Aged; Omeprazole - administration & dosage; Omeprazole - pharmacology; Omeprazole - therapeutic use; Pharmacology. Drug treatments; Human; Chemotherapy; Treatment; Antisecretory agent; Esophageal disease; Digestive diseases; Antiulcer agent; Barrett esophagus; Long term
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.1993.tb00143.x

SUMMARY Twenty‐three adult patients with a columnar lined (Barrett's) oesophagus are being treated with long‐term omeprazole, 40 mg daily. Twelve had never undergone anti‐reflux surgery (Group 1), the other eleven having previously had insertion of an Angelchik anti‐reflux prosthesis (Group 2). Endoscopy was carried out six months before, immediately before and six months, one year and two years into treatment. Multiple and standardized biopsies were taken at each endoscopy. Results from the two groups were similar. During the 6‐month run‐in period there was a statistically non‐significant increase in the linear extent of the columnar mucosa, but this showed a progressive, statistically significant decrease during the two years of treatment. Other evidence for regression of the Barrett's mucosa includes the emergence of large numbers of macroscopic squamous islands within the abnormal mucosa, an increase in the number of microscopic squamous islands, and microscopic squamous encroachment of the abnormal mucosa at the squamocolumnar junction. Histological assessment showed a reduction in the proportion of sulphomucin‐rich intestinal metaplasia, but this only achieved statistical significance in Group 1. The results substantiate the importance of acid in the pathogenesis of Barrett's oesophagus. Omeprazole may have a therapeutic role in bringing about regression of the metaplastic epithelium.