Failure of oesophageal acid control in candidates for Barrett's oesophagusreversal on a very high dose of proton pump inhibitor

Background: Normalization of oesophageal acid exposure using high dose prot on pump inhibitors in patients who are candidates for ablation therapy has been suggested to be essential for successful Barrett's reversal. However, the success rate for achieving pH normalization has not been determined. Methods: Patients with Barrett's oesophagus (2-6 cm in length) who were fou nd to be eligible for ablation therapy using multipolar electrocoagulation were included in this prospective study. Patients underwent an upper endosc opy to determine Barrett's length and other anatomic characteristics. Biops ies were obtained to rule out dysplasia. Subsequently, patients were treate d with omeprazole 40 mg b.d. Twenty-four hour oesophageal pH monitoring was performed after a mean period of 8.4 +/- 0.6 days of therapy. Results: Twenty-five patients were enrolled into the study. The pH test was abnormal in four (16%) of the study subjects. An additional two (8%) patie nts had abnormal supine percentage time with pH less than 4. There was no s ignificant difference in oesophageal acid control between patients with lon g vs. short segment Barrett's oesophagus. Elderly (> 60 years) patients ten ded to have less acid control than younger (less than or equal to 60 years) patients. Conclusions: Failure of oesophageal acid control in candidates for Barrett' s oesophagus reversal on very high dose of proton pump inhibitor is not unc ommon. Our study suggests that ambulatory 24-h oesophageal pH monitoring sh ould be considered in all candidates for Barrett's reversal who are treated with high dose proton pump inhibitor to ensure normalization of oesophagea l acid exposure.