Potent gastric acid inhibition in the management of Barrett's oesophagus

Barrett's oesophagus is the consequence of excessive and prolonged gastro-oesophageal reflux. The therapeutic objectives in Barrett's oesophagus include the reduction of gastro-oesophageal reflux in order to relieve symptoms and the prevention of the biologic progression to adenocarcinoma. The first objective may be achieved with standard proton pump inhibitor (PPI) therapy, which is the base of the medical therapy in this type of patients, but this therapy has been found not to be associated with normalization of the intraluminal pH of the oesophagus in many patients with Barrett's oesophagus. This condition seems to be necessary in order to reduce mucosal cell proliferation in some studies. Therefore, it has been proposed that patients with Barrett's oesophagus need profound acid inhibition with high-dose PPI. This therapeutic approach provides symptom relief, but there is no direct evidence that it is associated with Barrett's oesophagus regression or progression to adenocarcinoma. Nevertheless, recent and preliminary data suggest that long-term PPI therapy may reduce the risk of developing disease progression. Profound acid inhibition is also combined with endoscopy ablative or resection therapy in patients with Barrett's oesophagus. This therapeutic approach should be still regarded as experimental and more data are needed before its therapeutic role in patients with Barrett's oesophagus is established.