Oesophageal acid exposure: higher in Barrett's oesophagus than in reflux oesophagitis

Oesophageal acid exposure at different pH intervals between 0 and 8 in pati ents with Barrett's oesophagus (rt = 24) was compared with that in patients with reflux oesophagitis (n = 19) by using 24-h pH monitoring, Prior to th e monitoring, the position and pressure of the lower oesophageal sphincter was measured by manometry. Columnar epithelium with intestinal metaplasia a nd goblet cells was verified histologically in all Barrett patients and gra de I-III oesophagitis in patients with reflux oesophagitis. Acid exposure ( percentage of total time at pH < 4) in the Barrett group was significantly greater than in the oesophagitis group: 21.5 +/- 20.0% SD vs 11.1 +/- 11.7% SD (P < 0.01). The number of reflux episodes lasting longer than 5 min (re presenting oesophageal body Clearance function) was also significantly grea ter in the Barrett group (8.3 +/- 5.3 SD) than in the oesophagitis group (4 .5 +/- 4.7 SD) (P < 0.01). In the Barrett group the acid exposure time was greater at all pH intervals 0-1, 1-2, 2-3 and 3-4, (P < 0.01) but in the oe sophagitis group the exposure time was greater at pH interval 5-6 (P < 0.01 ). There was no significant difference in exposure at pH values above 7. Th e mean lower oesophageal sphincter pressure was equal in both groups (11.0 vs 11.3 mmHg). In conclusion, oesophageal acid exposure was significantly g reater in Barrett's oesophagus than in reflux oesophagitis, and this was as sociated with decreased oesophageal clearance function. In addition, the re sults indicated the need for special attention and perhaps higher dosages o f drugs to suppress acid production in patients with Barrett's oesophagus.