Continuous treatment with omeprazole 20 mg daily for up to 6 years in Barrett’s oesophagus

Abstract

Background: Because of the malignant potential of Barrett’s oesophagus, an aim of treatment is to cause the columnar epithelium to regress. A logical approach is to decrease acid reflux which is an important aetiological factor in Barrett’s oesophagus. Treatment with omeprazole 20–80 mg over 1–3 years has yielded conflicting but largely disappointing results. Aim: To determine if treatment of Barrett’s oesophagus with omeprazole 20 mg daily for up to 6 years can cause regression of the Barrett’s epithelium. Patients and Methods: Forty‐seven patients with Barrett’s oesophagus were treated in an open prospective study. Nine patients were treated for 2 years, 12 for 3 years, 10 for 4 years, eight for 5 years and eight for 6 years. Patients were endoscoped at 1–2‐year intervals and endoscoped at the end of the treatment period. Results: No significant shortening of the length of the Barrett’s segment was seen during any treatment period, although omeprazole controlled reflux symptoms and was well tolerated. Macroscopic squamous islands appeared in 55% of patients, mostly in the first 2–3 years although in five patients they appeared later in treatment. Conclusion: Treatment of Barrett’s oesophagus with omeprazole 20 mg daily for periods of up to 6 years did not cause regression in the length of the Barrett’s segment, but it did lead in over half of the patients to partial re‐epithelialization in the form of squamous islands.

Role of Acid Suppression in the Development and Progression of Dysplasia in Patients with Barrett’s Esophagus

“…The importance of these islands is not clear. In conclusion, published trials provide evidence of the development of squamous islands during PPI therapy, but there is no convincing evidence of regression of BE as a result of pharmacological acid suppression [63,64,65]. Regression of Barrett’s epithelium may occur after antireflux surgery as well.…”

Systematic review: proton‐pump inhibitor failure in gastro‐oesophageal reflux disease – where next?

“…In one study, all BE patients receiving omeprazole 20 mg once daily were maintained symptom-free. 30 However, several studies using high dose of PPIs (omeprazole 80 mg, lansoprazole 60 mg and omeprazole 60 mg once daily) demonstrated complete heartburn resolution in 80-85% of the patients. 28, 31, 32…”

Endoscopic ablation of Barrett's oesophagus: a randomized‐controlled trial of photodynamic therapy vs. argon plasma coagulation

“…6,10 Although it is well recognized that reflux is the stimulus for the development of intestinal metaplasia, control of reflux, whether by medical or surgical means, unfortunately appears to have little impact in reversing the metaplasia. 11,12 Presently, it is also not possible to predict which patients will develop dysplasia, and thus current recommendations 13 advocate regular surveillance of the epithelium with the aim of detecting dysplastic change, since early surgical intervention is associated with improved survival benefit. 14 It is now known that ablation of the abnormal mucosa in an anacidic environment is associated with the regrowth of squamous epithelium, 15 which theoretically may reduce the risk of progression to malignancy and has the potential advantage of avoiding surgery, which is associated with significant morbidity and mortality.…”