Long term continuous omeprazole treatment of patients with Barrett's oesophagus

SUMMARY Background: The metaplastic columnar epithelium in Barrett's oesophagus has malignant potential. Aim: To determine whether decreasing acid reflux leads to regression of Barrett's epithelium. Method: Twenty‐four patients with Barrett's oesophagus were treated with omeprazole 20 mg o.m. in an open, prospective study; 11 were treated for 12 months, and 13 for 24 months. Another group of 17 patients with Barrett's oesophagus was treated with an H2‐receptor antagonist in standard dosage for 12‐36 (mean 23) months. Patients were assessed endoscopically. Results: No evidence of significant shortening of the length of Barrett's oesophagus was seen in any patient treated for 12 or 24 months with omeprazole. Similarly, no shortening of the length of Barrett's oesophagus was seen in any patient treated with an H2‐receptor antagonist. However, 6 of 11 patients treated with omeprazole for 12 months, and 7 of 13 treated for 24 months, developed macroscopic squamous islands visible below the squamo‐columnar junction. This was not seen in any patient treated with an H2‐receptor antagonist. Conclusion: Although there can be reappearance of squamous epithelium in Barrett's oesophagus of some patients during treatment with omeprazole 20 mg o.m. over 12–24 months, a significant shortening of the columnar lined segment is not seen.