RELATION BETWEEN ESOPHAGEAL ACID EXPOSURE AND HEALING OF ESOPHAGITIS WITH OMEPRAZOLE IN PATIENTS WITH SEVERE REFLUX ESOPHAGITIS

Background/aims-Reducing oesophageal acid exposure by suppressing acid secretion with omeprazole is highly effective in healing reflux oesop hagitis. Some patients with severe oesophagitis, fail to heal and whet her this results from inadequate acid suppression or other factors is unclear. The aim of this study, was to investigate the relation betwee n oesophageal acid exposure and healing in patients with severe reflux oesophagitis treated with omeprazole. Methods-Sixty one patients with grade 3 or 4 ulcerative oesophagitis were treated for eight weeks wit h omeprazole 20 mg every morning. Those patients unhealed at eight wee ks were treated with 40 mg every morning for a further eight weeks. En doscopy and 24 hour oesophageal pH monitoring were performed before tr eatment and at the end of each treatment phase while receiving treatme nt. Results-Thirty per cent of patients failed to heal with the 20 mg dose. Unhealed patients had greater total 24 hour oesophageal acid exp osure before treatment, and while receiving treatment also had greater acid exposure and a smaller reduction in acid exposure than did patie nts who healed. Forty seven per cent of the unhealed patients also fai led to heal with the 40 mg dose. These patients had similar levels of acid exposure before treatment to those who healed, but had greater ac id exposure while receiving treatment, particularly at night when supi ne. Conclusions-Patients with severe ulcerative oesophagitis who are r efractory to omeprazole have greater oesophageal acid exposure while r eceiving treatment than responding patients. This is due to a reduced responsiveness to acid suppression, and is likely to be an important f actor underlying the failure of the oesophagitis to heal.