Successful elimination of reflux symptoms does not insure adequate control of acid reflux in patients with Barrett's esophagus.

Abstract

Patients with Barrett's metaplasia of the esophagus often lack the appropriate amount of heartburn for their severity of gastroesophageal reflux. Therefore, we studied patients with Barrett's metaplasia by prolonged ambulatory pH monitoring after completely suppressing their heartburn symptoms to determine whether acid reflux was underestimated in symptom assessment. Five patients with Barrett's esophagus, all of whom presented with heartburn, were treated with omeprazole (20-60 mg/day) until they were asymptomatic. Twenty-four-hour pH ambulatory monitoring was performed while they were on omeprazole. Four of five patients showed persistent abnormal gastroesophageal reflux after treatment with omeprazole. Two patients showed abnormally increased supine reflux and two patients had an abnormal increase in both supine and upright reflux. Only one patient had complete inhibition of the acid reflux by the omeprazole (20 mg b.i.d.). Treating the patient with Barrett's esophagus to the endpoint of eradication of heartburn does not insure adequate control of acid reflux. Prolonged ambulatory pH monitoring of the esophagus should be conducted to demonstrate that an adequate dose of omeprazole has been given, despite symptomatic improvement.