24-h pH monitoring is necessary to assess acid reflux suppression in patients with Barrett's oesophagus undergoing treatment with proton pump inhibitors

Background: Control of acid reflux is the main objective of treatment for B arrett's oesophagus. However, as these patients have a reduced sensitivity to acid reflux, disappearance of symptoms may not correlate with efficient control of acid reflux. The aim of this study was to determine in a group o f patients with Barrett's oesophagus whether treatment with proton pump inh ibitors suppressed pathological acid reflux once the symptoms of reflux had been controlled and the associated inflammatory lesions cured. Methods: Eighteen consecutive patients with Barrett's oesophagus were studi ed, all of whom presented with heartburn. Twenty-four-hour oesophageal pH m onitoring before treatment showed pathological acid reflux in all cases: me dian percentage of total time with pH less than 4, 22 (range 8-52) per cent . All patients received proton pump inhibitors (dose 20-60 mg/day) until sy mptoms were controlled. Results: While on therapy, pH was reduced (median percentage of total time with pH less than 4, 3 venus 22 per cent; P < 0.001). However, three patien ts had persistent pathological rates of acid reflux. Conclusion: Disappearance of symptoms is not a good indicator of control of pathological acid reflux: in patients with Barrett's oesophagus. Twenty-fo ur-hour pH monitoring should be performed for proper adjustment of the dose of medication.