Effect of omeprazole 20 mg twice daily on duodenogastric andgastro-oesophageal bile reflux in Barrett's oesophagus

Background—Both acid and duodenal contents arethought to be responsible for the mucosal damage in Barrett'soesophagus, a condition often treated medically. However, little isknown about the effect of omeprazole on duodenogastric reflux (DGR) andduodenogastro-oesophageal reflux (DGOR).
Aims—To study the effect of omeprazole 20 mgtwice daily on DGR and DGOR, using the technique of ambulatorybilirubin monitoring.
Methods—Twenty three patients with Barrett'soesophagus underwent manometry followed by 24 hour oesophageal andgastric pH monitoring. In conjunction with pH monitoring, 11 patients(group 1) underwent oesophageal bilirubin monitoring and 12 patients (group 2) underwent gastric bilirubin monitoring, both before andduring treatment with omeprazole 20 mg twice daily.
Results—In both groups there was a significantreduction in oesophageal acid (pH<4) reflux (p<0.005) and asignificant increase in the time gastric pH was above 4 (p<0.005). Ingroup 1, median total oesophageal bilirubin exposure was significantlyreduced from 28.9% to 2.4% (p<0.005). In group 2, median totalgastric bilirubin exposure was significantly reduced from 24.9% to7.2% (p<0.005).
Conclusions—Treatment of Barrett's oesophaguswith omeprazole 20 mg twice daily results in a notable reduction in theexposure of the oesophagus to both acid and duodenal contents. Inaddition, delivery of duodenal contents to the upper gastric body is reduced.

Keywords:bilirubin monitoring; Barrett's oesophagus; omeprazole; pH monitoring; duodenogastric reflux; duodenogastro-oesophageal reflux