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Proton pump inhibitors for Barrett's oesophagus
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Introduction |
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Barrett's oesophagus is a metaplastic condition in which the normal squamous oesophageal epithelium is replaced by specialised intestinal metaplasia.1 Barrett's oesophagus occurs in about 10% of patients with gastro-oesophageal reflux disease (GORD) and predisposes to dysplasia and adenocarcinoma.2 The incidence of oesophageal and gastric cardia adenocarcinoma is rapidly increasing by a rate exceeding that of any other cancer.3 4 Over the past decade, acid suppression with proton pump inhibitors (PPIs) has become the mainstay of treatment of patients with Barrett's oesophagus. This article reviews the specific end points of such treatment.
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Control of reflux symptoms |
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Concomitant symptomatic GORD is common in patients with Barrett's
oesophagus and manifests as heartburn, regurgitation, dysphagia, or
chest pain.5 Numerous trials have documented that PPIs
provide superior relief of heartburn compared with
H2-receptor antagonists (H2RAs). In a recent
meta-analysis of GORD studies of patients with endoscopically proved
erosive oesophagitis, PPIs, irrespective of dose or duration of
treatment,
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