Ultrasonographic evaluation of lansoprazole-induced improvement of submucosal injury in patients with gastroesophageal reflux

OBJECTIVE: Endoscopic ultrasonographic (EUS) changes in,gastroesophageal re flux disease (GERD) after treatment with proton pump inhibitor have been po orly evaluated. We conducted a randomized, double-blind 12-wk clinical tria l to compare the EUS effects of lansoprazole to histamine H-2-receptor anta gonist therapy in GERD. METHODS: Seventeen patients with reflux-related symptoms received 40 mg of famotidine for 6 wk or 30 mg of lansoprazole for 6 wk followed by 30 mg of famotidine or 30 mg of lansoprazole for another 6 wk, respectively. Patient s underwent EUS before and at 6 and 12 wk after treatment. RESULTS: Before treatment, a variable degree of wall thickening was noted o n EUS in the lower esophagus, compared with 20 normal subjects. After 6 wk of therapy, esophageal wall was significantly thicker in the famotidine gro up compared with the lansoprazole group (p < 0.01). Surprisingly, thickenin g of esophageal wall and abnormal architecture were also detected in endosc opically negative reflux disease. Lansoprazole was superior to famotidine i n reducing the thickness of esophageal wall. CONCLUSIONS: EUS was very useful for evaluation of submucosal injury in pat ients with GERD. EUS showed that a 6-wk course of lansoprazole therapy redu ced thickening of esophageal wall, which was resistant to histamine Hz-rece ptor antagonist therapy. Our results also suggest that inflammatory damage to the submucosal and muscle layers of the lower esophagus is the underlyin g mechanism of heartburn and associated symptoms in patients with endoscopi cally negative reflux disease. (C) 2000 by Am. Cell. of Gastroenterology.