Endoscopic regression of Barrett's oesophagus during omeprazole treatment; a randomised double blind study

Abstract

Background: Barrett's oesophagus, columnar metaplasia of the epithelium, is a premalignant condition with a 50-100-fold increased risk of cancer. The condition is caused by chronic gastro-oesophageal reflux. Regression of metaplasia may decrease the cancer risk.

Aims: To determine whether elimination of acid gastro-oesophageal reflux induces a regression of metaplastic epithelium.

Methods: Sixty eight patients with acid reflux and proven Barrett's oesophagus were included in a prospective, randomised, double blind study with parallel groups, and were treated with profound acid secretion suppression with omeprazole 40 mg twice daily, or with mild acid secretion suppression with ranitidine 150 mg twice daily, for 24 months. Endoscopy was performed at 0, 3, 9, 15, and 24 months with measurement of length and surface area of Barrett's oesophagus; pH-metry was performed at 0 and 3 months. Per protocol analysis was performed on 26 patients treated with omeprazole, and 27 patients treated with ranitidine.

Results: Omeprazole reduced reflux to 0.1%, ranitidine to 9.4% per 24 hours. Symptoms were ameliorated in both groups. There was a small, but statistically significant regression of Barrett's oesophagus in the omeprazole group, both in length and in area. No change was observed in the ranitidine group. The difference between the regression in the omeprazole and ranitidine group was statistically significant for the area of Barrett's oesophagus (p=0. 02), and showed a trend in the same direction for the length of Barrett's oesophagus (p=0.06).

Conclusions: Profound suppression of acid secretion, leading to elimination of acid reflux, induces partial regression of Barrett's oesophagus.

Figure 1

Example of a drawing, sketched on graph paper, with the squamocolumnar junction, two squamous islands within Barrett's epithelium, and the oesophagogastric junction.

Figure 2

Relative changes in length of Barrett's oesophagus in the omeprazole and ranitidine treated patients (mean values (SEM)) at 3, 9, 15 and 24 months, compared with baseline.

Figure 3

Relative changes in surface area of Barrett's oesophagus in the omeprazole and ranitidine treated patients (mean values (SEM)) at 3, 9, 15, and 24 months, compared with baseline.