Maximal acid reflux control for Barrett’s oesophagus: feasible and effective
Introduction: The treatment of patients with Barrett’s oesophagus is controversial. Debate exists regarding the use and value of high dose acid suppression as the standard of practice. Despite prolonged use of high dose proton pump inhibitors (40 mg omeprazole, 60 mg lansoprazole), most studies have...
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| Veröffentlicht in: | Alimentary pharmacology & therapeutics 2001-04, Vol.15 (4), p.519-524 |
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| creator | Srinivasan, R. Katz, P. O. Ramakrishnan, A. Katzka, D. A. Vela, M. F. Castell, D. O. |
| description | Introduction:
The treatment of patients with Barrett’s oesophagus is controversial. Debate exists regarding the use and value of high dose acid suppression as the standard of practice. Despite prolonged use of high dose proton pump inhibitors (40 mg omeprazole, 60 mg lansoprazole), most studies have shown no convincing evidence of significant regression of Barrett’s length. These studies, however, have used fixed doses of proton pump inhibitors and did not regularly document control of oesophageal acid exposure.
Aim:
To determine whether regression of Barrett’s epithelium can be achieved with documented maximal acid suppression.
Methods:
We have prospectively followed nine patients with Barrett’s oesophagus (eight male; mean age 60 years) for more than 1 year. They were all treated using medical therapy with pH monitoring documenting oesophageal acid exposure over 24 h |
| doi_str_mv | 10.1046/j.1365-2036.2001.00958.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_77021965</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>77021965</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4428-c97f55c8e5835fbbb7b8276387898cc98be6f9779efdf3fb25a639e5e1f415753</originalsourceid><addsrcrecordid>eNqNkM1OGzEQx62KqqRpXwFZQuK2iz_WX4gLoFIqpdADPVteZwwbOdlg79Jw4zX6ejwJu00E155mpPnNjP4_hDAlJSWVPF6UlEtRMMJlyQihJSFG6HLzAU3eBntoQpg0BdOU76PPOS8IIVIR9gntU8p0pTSdoOufbtMsXcTON3OcIMR-g3276lIbcWgTPncpQde9PP_NuIXcru_dXZ9PcACXmzoCdqs5hhDAd80jfEEfg4sZvu7qFP2-_HZ7cVXMbr7_uDibFb6qmC68UUEIr0FoLkJd16rWTEmulTbae6NrkMEoZSDMAw81E05yAwJoqKhQgk_R0fbuOrUPPeTOLpvsIUa3grbPVg05qZEjqLegT23OQz67TkPe9GQpsaNLu7CjMjsqs6NL-8-l3QyrB7sffb2E-fviTt4AHO4Al72LIbmVb_IbZyjnhg_U6Zb600R4-u_39uzX7dDwV_Cnj9s</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>77021965</pqid></control><display><type>article</type><title>Maximal acid reflux control for Barrett’s oesophagus: feasible and effective</title><source>Wiley Free Content</source><source>MEDLINE</source><source>IngentaConnect Free/Open Access Journals</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Srinivasan, R. ; Katz, P. O. ; Ramakrishnan, A. ; Katzka, D. A. ; Vela, M. F. ; Castell, D. O.</creator><creatorcontrib>Srinivasan, R. ; Katz, P. O. ; Ramakrishnan, A. ; Katzka, D. A. ; Vela, M. F. ; Castell, D. O.</creatorcontrib><description>Introduction:
The treatment of patients with Barrett’s oesophagus is controversial. Debate exists regarding the use and value of high dose acid suppression as the standard of practice. Despite prolonged use of high dose proton pump inhibitors (40 mg omeprazole, 60 mg lansoprazole), most studies have shown no convincing evidence of significant regression of Barrett’s length. These studies, however, have used fixed doses of proton pump inhibitors and did not regularly document control of oesophageal acid exposure.
Aim:
To determine whether regression of Barrett’s epithelium can be achieved with documented maximal acid suppression.
Methods:
We have prospectively followed nine patients with Barrett’s oesophagus (eight male; mean age 60 years) for more than 1 year. They were all treated using medical therapy with pH monitoring documenting oesophageal acid exposure over 24 h < 1.6% of the time, and with two or more esophagogastroduodenoscopies performed by the same endoscopist.
Results:
Acid control was individually tailored and achieved with proton pump inhibitor b.d. (omeprazole 20 mg or lansoprazole 30 mg) and ranitidine at bedtime (HS) (Ran) if necessary. All nine patients (100%) showed some evidence of regression. All nine patients (100%) showed a decrease in Barrett’s length (mean 2 cm, range 1–3 cm). Six out of nine (66.67%) patients showed evidence of squamous islands on the last oesophagogastroduodenoscopy. The mean total distal oesophageal acid exposure was 0.38% (range: 0–1.5%). The mean follow‐up of patients was 54 months (range: 13–118 months).
Conclusions:
Consistent and individually tailored maximal acid suppression documented by pH‐metry is achievable and may result in decreased length and development of squamous islands in patients with Barrett’s epithelium. This approach should be further evaluated as potentially the preferred medical treatment for these patients.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1046/j.1365-2036.2001.00958.x</identifier><identifier>PMID: 11284781</identifier><language>eng</language><publisher>Oxford UK: Blackwell Science Ltd</publisher><subject>2-Pyridinylmethylsulfinylbenzimidazoles ; Adult ; Aged ; Anti-Ulcer Agents - pharmacology ; Anti-Ulcer Agents - therapeutic use ; Barrett Esophagus - drug therapy ; Barrett Esophagus - pathology ; Biological and medical sciences ; Digestive system ; Endoscopy, Digestive System ; Epithelium - pathology ; Esophagus - pathology ; Female ; Gastric Acid - physiology ; Humans ; Hydrogen-Ion Concentration ; Lansoprazole ; Male ; Medical sciences ; Middle Aged ; Omeprazole - analogs & derivatives ; Omeprazole - pharmacology ; Omeprazole - therapeutic use ; Pharmacology. Drug treatments ; Proton Pump Inhibitors ; Ranitidine - pharmacology ; Ranitidine - therapeutic use</subject><ispartof>Alimentary pharmacology & therapeutics, 2001-04, Vol.15 (4), p.519-524</ispartof><rights>2001 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4428-c97f55c8e5835fbbb7b8276387898cc98be6f9779efdf3fb25a639e5e1f415753</citedby><cites>FETCH-LOGICAL-c4428-c97f55c8e5835fbbb7b8276387898cc98be6f9779efdf3fb25a639e5e1f415753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1046%2Fj.1365-2036.2001.00958.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.1365-2036.2001.00958.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=913393$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11284781$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Srinivasan, R.</creatorcontrib><creatorcontrib>Katz, P. O.</creatorcontrib><creatorcontrib>Ramakrishnan, A.</creatorcontrib><creatorcontrib>Katzka, D. A.</creatorcontrib><creatorcontrib>Vela, M. F.</creatorcontrib><creatorcontrib>Castell, D. O.</creatorcontrib><title>Maximal acid reflux control for Barrett’s oesophagus: feasible and effective</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Introduction:
The treatment of patients with Barrett’s oesophagus is controversial. Debate exists regarding the use and value of high dose acid suppression as the standard of practice. Despite prolonged use of high dose proton pump inhibitors (40 mg omeprazole, 60 mg lansoprazole), most studies have shown no convincing evidence of significant regression of Barrett’s length. These studies, however, have used fixed doses of proton pump inhibitors and did not regularly document control of oesophageal acid exposure.
Aim:
To determine whether regression of Barrett’s epithelium can be achieved with documented maximal acid suppression.
Methods:
We have prospectively followed nine patients with Barrett’s oesophagus (eight male; mean age 60 years) for more than 1 year. They were all treated using medical therapy with pH monitoring documenting oesophageal acid exposure over 24 h < 1.6% of the time, and with two or more esophagogastroduodenoscopies performed by the same endoscopist.
Results:
Acid control was individually tailored and achieved with proton pump inhibitor b.d. (omeprazole 20 mg or lansoprazole 30 mg) and ranitidine at bedtime (HS) (Ran) if necessary. All nine patients (100%) showed some evidence of regression. All nine patients (100%) showed a decrease in Barrett’s length (mean 2 cm, range 1–3 cm). Six out of nine (66.67%) patients showed evidence of squamous islands on the last oesophagogastroduodenoscopy. The mean total distal oesophageal acid exposure was 0.38% (range: 0–1.5%). The mean follow‐up of patients was 54 months (range: 13–118 months).
Conclusions:
Consistent and individually tailored maximal acid suppression documented by pH‐metry is achievable and may result in decreased length and development of squamous islands in patients with Barrett’s epithelium. This approach should be further evaluated as potentially the preferred medical treatment for these patients.</description><subject>2-Pyridinylmethylsulfinylbenzimidazoles</subject><subject>Adult</subject><subject>Aged</subject><subject>Anti-Ulcer Agents - pharmacology</subject><subject>Anti-Ulcer Agents - therapeutic use</subject><subject>Barrett Esophagus - drug therapy</subject><subject>Barrett Esophagus - pathology</subject><subject>Biological and medical sciences</subject><subject>Digestive system</subject><subject>Endoscopy, Digestive System</subject><subject>Epithelium - pathology</subject><subject>Esophagus - pathology</subject><subject>Female</subject><subject>Gastric Acid - physiology</subject><subject>Humans</subject><subject>Hydrogen-Ion Concentration</subject><subject>Lansoprazole</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Omeprazole - analogs & derivatives</subject><subject>Omeprazole - pharmacology</subject><subject>Omeprazole - therapeutic use</subject><subject>Pharmacology. Drug treatments</subject><subject>Proton Pump Inhibitors</subject><subject>Ranitidine - pharmacology</subject><subject>Ranitidine - therapeutic use</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkM1OGzEQx62KqqRpXwFZQuK2iz_WX4gLoFIqpdADPVteZwwbOdlg79Jw4zX6ejwJu00E155mpPnNjP4_hDAlJSWVPF6UlEtRMMJlyQihJSFG6HLzAU3eBntoQpg0BdOU76PPOS8IIVIR9gntU8p0pTSdoOufbtMsXcTON3OcIMR-g3276lIbcWgTPncpQde9PP_NuIXcru_dXZ9PcACXmzoCdqs5hhDAd80jfEEfg4sZvu7qFP2-_HZ7cVXMbr7_uDibFb6qmC68UUEIr0FoLkJd16rWTEmulTbae6NrkMEoZSDMAw81E05yAwJoqKhQgk_R0fbuOrUPPeTOLpvsIUa3grbPVg05qZEjqLegT23OQz67TkPe9GQpsaNLu7CjMjsqs6NL-8-l3QyrB7sffb2E-fviTt4AHO4Al72LIbmVb_IbZyjnhg_U6Zb600R4-u_39uzX7dDwV_Cnj9s</recordid><startdate>200104</startdate><enddate>200104</enddate><creator>Srinivasan, R.</creator><creator>Katz, P. O.</creator><creator>Ramakrishnan, A.</creator><creator>Katzka, D. A.</creator><creator>Vela, M. F.</creator><creator>Castell, D. O.</creator><general>Blackwell Science Ltd</general><general>Blackwell</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200104</creationdate><title>Maximal acid reflux control for Barrett’s oesophagus: feasible and effective</title><author>Srinivasan, R. ; Katz, P. O. ; Ramakrishnan, A. ; Katzka, D. A. ; Vela, M. F. ; Castell, D. O.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4428-c97f55c8e5835fbbb7b8276387898cc98be6f9779efdf3fb25a639e5e1f415753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>2-Pyridinylmethylsulfinylbenzimidazoles</topic><topic>Adult</topic><topic>Aged</topic><topic>Anti-Ulcer Agents - pharmacology</topic><topic>Anti-Ulcer Agents - therapeutic use</topic><topic>Barrett Esophagus - drug therapy</topic><topic>Barrett Esophagus - pathology</topic><topic>Biological and medical sciences</topic><topic>Digestive system</topic><topic>Endoscopy, Digestive System</topic><topic>Epithelium - pathology</topic><topic>Esophagus - pathology</topic><topic>Female</topic><topic>Gastric Acid - physiology</topic><topic>Humans</topic><topic>Hydrogen-Ion Concentration</topic><topic>Lansoprazole</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Omeprazole - analogs & derivatives</topic><topic>Omeprazole - pharmacology</topic><topic>Omeprazole - therapeutic use</topic><topic>Pharmacology. Drug treatments</topic><topic>Proton Pump Inhibitors</topic><topic>Ranitidine - pharmacology</topic><topic>Ranitidine - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Srinivasan, R.</creatorcontrib><creatorcontrib>Katz, P. O.</creatorcontrib><creatorcontrib>Ramakrishnan, A.</creatorcontrib><creatorcontrib>Katzka, D. A.</creatorcontrib><creatorcontrib>Vela, M. F.</creatorcontrib><creatorcontrib>Castell, D. O.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Srinivasan, R.</au><au>Katz, P. O.</au><au>Ramakrishnan, A.</au><au>Katzka, D. A.</au><au>Vela, M. F.</au><au>Castell, D. O.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Maximal acid reflux control for Barrett’s oesophagus: feasible and effective</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2001-04</date><risdate>2001</risdate><volume>15</volume><issue>4</issue><spage>519</spage><epage>524</epage><pages>519-524</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Introduction:
The treatment of patients with Barrett’s oesophagus is controversial. Debate exists regarding the use and value of high dose acid suppression as the standard of practice. Despite prolonged use of high dose proton pump inhibitors (40 mg omeprazole, 60 mg lansoprazole), most studies have shown no convincing evidence of significant regression of Barrett’s length. These studies, however, have used fixed doses of proton pump inhibitors and did not regularly document control of oesophageal acid exposure.
Aim:
To determine whether regression of Barrett’s epithelium can be achieved with documented maximal acid suppression.
Methods:
We have prospectively followed nine patients with Barrett’s oesophagus (eight male; mean age 60 years) for more than 1 year. They were all treated using medical therapy with pH monitoring documenting oesophageal acid exposure over 24 h < 1.6% of the time, and with two or more esophagogastroduodenoscopies performed by the same endoscopist.
Results:
Acid control was individually tailored and achieved with proton pump inhibitor b.d. (omeprazole 20 mg or lansoprazole 30 mg) and ranitidine at bedtime (HS) (Ran) if necessary. All nine patients (100%) showed some evidence of regression. All nine patients (100%) showed a decrease in Barrett’s length (mean 2 cm, range 1–3 cm). Six out of nine (66.67%) patients showed evidence of squamous islands on the last oesophagogastroduodenoscopy. The mean total distal oesophageal acid exposure was 0.38% (range: 0–1.5%). The mean follow‐up of patients was 54 months (range: 13–118 months).
Conclusions:
Consistent and individually tailored maximal acid suppression documented by pH‐metry is achievable and may result in decreased length and development of squamous islands in patients with Barrett’s epithelium. This approach should be further evaluated as potentially the preferred medical treatment for these patients.</abstract><cop>Oxford UK</cop><pub>Blackwell Science Ltd</pub><pmid>11284781</pmid><doi>10.1046/j.1365-2036.2001.00958.x</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | 2-Pyridinylmethylsulfinylbenzimidazoles Adult Aged Anti-Ulcer Agents - pharmacology Anti-Ulcer Agents - therapeutic use Barrett Esophagus - drug therapy Barrett Esophagus - pathology Biological and medical sciences Digestive system Endoscopy, Digestive System Epithelium - pathology Esophagus - pathology Female Gastric Acid - physiology Humans Hydrogen-Ion Concentration Lansoprazole Male Medical sciences Middle Aged Omeprazole - analogs & derivatives Omeprazole - pharmacology Omeprazole - therapeutic use Pharmacology. Drug treatments Proton Pump Inhibitors Ranitidine - pharmacology Ranitidine - therapeutic use |
| title | Maximal acid reflux control for Barrett’s oesophagus: feasible and effective |
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