24-h pH monitoring is necessary to assess acid reflux suppression in patients with Barrett's oesophagus undergoing treatment with proton pump inhibitors

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Abstract
Background: Control of acid reflux is the main objective of treatment for Barrett's oesophagus. However, as these patients have a reduced sensitivity to acid reflux, disappearance of symptoms may not correlate with efficient control of acid reflux. The aim of this study was to determine in a group of patients with Barrett's oesophagus whether treatment with proton pump inhibitors suppressed patho- logical acid reflux once the symptoms of reflux had been controlled and the associated inflammatory lesions cured. Methods: Eighteen consecutive patients with Barrett's oesophagus were studied, all of whom presented with heartburn. Twenty-four-hour oesophageal pH monitoring before treatment showed pathological acid reflux in all cases: median percentage of total time with pH less than 4, 22 (range 8–52) per cent. All patients received proton pump inhibitors (dose 20–60 mg/day) until symptoms were controlled. Results: While on therapy, pH was reduced (median percentage of total time with pH less than 4, 3 versus 22 per cent; P < 0·001). However, three patients had persistent pathological rates of acid reflux. Conclusion: Disappearance of symptoms is not a good indicator of control of pathological acid reflux in patients with Barrett's oesophagus. Twenty-four-hour pH monitoring should be performed for proper adjustment of the dose of medication.