Proton pump inhibitors for Barrett's oesophagus

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Abstract
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