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Leading article
Proton pump inhibitors for Barrett's oesophagus
  1. G TRIADAFILOPOULOS, Professor of Medicine
  1. Stanford University School of Medicine
  2. Chief, Gastroenterology Section (111-GI)
  3. Veterans Affairs Palo Alto Health Care System
  4. 3801 Miranda Avenue
  5. Palo Alto, CA 94304, USA
  6. email: vagt@leland.stanford.edu

    https://doi.org/10.1136/gut.46.2.144

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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.

      Control of reflux symptoms

      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, provide the greatest overall symptom relief, with 77.4% (10.4%) of patients becoming heartburn-free, which was significantly better than with H2RAs (47.6% (15.5%)). Furthermore, PPIs provide faster complete heartburn relief (11.5%/week) than H2RAs (6.4%/week).6 As a group, however, patients with Barrett's oesophagus have greater exposure to oesophageal acid than other patients with GORD7 8 and control of symptoms may require higher than usual doses of PPIs.9 10 Even with PPI therapy, however, a subgroup of patients may still have acid regurgitation in spite of control of oesophageal acid exposure.11 Of note, elderly patients over 65 years of age with Barrett's oesophagus may be much less symptomatic than their younger counterparts and may not require antisecretory therapy.5

      Healing of coexistent oesophagitis

      Healing of coexistent oesophagitis is an important goal of treatment in patients with Barrett's oesophagus. Elimination of erosive oesophagitis or …

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      Footnotes

      • Leading articles express the views of the author and not those of the editor and editorial board.

      • Abbreviations used in this article:
        DGOR
        duodenogastro-oesophageal reflux
        GORD
        gastro-oesophageal reflux disease
        H2RA
        H2-receptor antagonist
        PPI
        proton pump inhibitor