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Oesophagus
Endoscopic regression of Barrett’s oesophagus during omeprazole treatment; a randomised double blind study
  1. F T M Petersa,
  2. S Ganeshc,
  3. E J Kuipersd,
  4. W J Sluiterb,
  5. E C Klinkenberg-Knold,
  6. C B H W Lamersc,
  7. J H Kleibeukera
  1. aDepartment of Gastroenterology and Hepatology, University Hospital Groningen, Groningen, The Netherlands, bDepartment of Endocrinology, University Hospital Groningen, Groningen, The Netherlands, cDepartment of Gastroenterology and Hepatology, University Hospital Leiden, Leiden, The Netherlands, dDepartment of Gastroenterology and Hepatology, Free University Hospital Amsterdam, Amsterdam, The Netherlands
  1. Dr F T M Peters, University Hospital Groningen, Department of Gastroenterology, PO Box 30.001, 9700 RB Groningen, The Netherlands.

Abstract

BACKGROUND Barrett’s oesophagus, columnar metaplasia of the epithelium, is a premalignant condition with a 50–100-fold increased risk of cancer. The condition is caused by chronic gastro-oesophageal reflux. Regression of metaplasia may decrease the cancer risk.

AIMS To determine whether elimination of acid gastro-oesophageal reflux induces a regression of metaplastic epithelium.

METHODS Sixty eight patients with acid reflux and proven Barrett’s oesophagus were included in a prospective, randomised, double blind study with parallel groups, and were treated with profound acid secretion suppression with omeprazole 40 mg twice daily, or with mild acid secretion suppression with ranitidine 150 mg twice daily, for 24 months. Endoscopy was performed at 0, 3, 9, 15, and 24 months with measurement of length and surface area of Barrett’s oesophagus; pH-metry was performed at 0 and 3 months. Per protocol analysis was performed on 26 patients treated with omeprazole, and 27 patients treated with ranitidine.

RESULTS Omeprazole reduced reflux to 0.1%, ranitidine to 9.4% per 24 hours. Symptoms were ameliorated in both groups. There was a small, but statistically significant regression of Barrett’s oesophagus in the omeprazole group, both in length and in area. No change was observed in the ranitidine group. The difference between the regression in the omeprazole and ranitidine group was statistically significant for the area of Barrett’s oesophagus (p=0.02), and showed a trend in the same direction for the length of Barrett’s oesophagus (p=0.06).

CONCLUSIONS Profound suppression of acid secretion, leading to elimination of acid reflux, induces partial regression of Barrett’s oesophagus.

  • acid reflux
  • Barrett’s oesophagus
  • omeprazole
  • regression

  • Abbreviations used in this paper

    GORD
    gastro-oesophageal reflux disease
    AUC
    area under the curve
    CI
    confidence interval

    • https://doi.org/10.1136/gut.45.4.489

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    • Abbreviations used in this paper

      GORD
      gastro-oesophageal reflux disease
      AUC
      area under the curve
      CI
      confidence interval
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