Effect of omeprazole on antral duodenogastric reflux in Barrett oesophagus

Background: The effect of long-term acid suppression therapy in Barrett oes ophagus remains unknown, hut the high intragastric pH generated has been sh own to increase the cytotoxicity of duodenal refluxate on foregut mucosa. H owever, recent work suggests that duodenogastric reflux (DGR) may be reduce d by omeprazole. Aim: To investigate the effect of omeprazole on the reflux of duodenal contents into the gastric antrum in Barrett patients and healt hy subjects. Method: Fifteen patients with Barrett oesophagus and 14 health y subjects underwent oesophageal manometry followed by 24-h ambulatory oeso phageal and gastric pH and gastric bilirubin monitoring. The bilirubin sens or (modified by the addition of a weighted tip to facilitate manoeuvrabilit y) was sited in the gastric antrum under fluoroscopic control. Combined amb ulatory pH and bilirubin monitoring was repented after 2 weeks on omeprazol e 20 mg b.d. Results: Changes in oesophageal acid reflux and gastric alkali ne shift due to omeprazole were as expected (P < 0.001). There was no diffe rence in total antral DGR between the Barrett and control groups (P=0.56), and omeprazole had no significant effect on DGR in either group (P=0.77 and 0.27, respectively). Conclusions: DGR into the antrum is of a similar leve l in Barrett patients and healthy controls. Omeprazole does not reduce the reflux of duodenal contents across the pylorus. Further work is required on the increased cytotoxic potential of continuing DGR in those on long-term acid suppression.