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Is symptom control the correct end point for proton pump inhibitor treatment in Barrett’s oesophagus?

We have recently reported that abnormal acid reflux persists in up to 50% of patients with long segment Barrett’s oesophagus, despite good control of symptoms of gastro-oesophageal reflux disease (GORD) with proton pump inhibitor (PPI) therapy.1 The critical question is whether such persistence of abnormal acid reflux alters the risk of progression to adenocarcinoma. We investigated this issue by studying cellular proliferation and expression of cyclin D1, which is an important marker of neoplastic progression,2,3 in patients with Barrett’s oesophagus on PPI therapy.

A prospective cross-sectional survey of 20 patients with long segment Barrett’s oesophagus (defined as a length ⩾3 cm and presence of specialised intestinal epithelium containing alcian blue staining goblet cells) was conducted. In all cases, GORD symptoms had been well controlled with PPI therapy (omeprazole n = 13 patients, median dose 20 mg (range 10–40); lansoprazole n = 5, 30 mg; or rabeprazole n = 2, 20 mg). Patients had received PPI …