Sampliner R E
University of Arizona Health Sciences Center, Tucson.
Am J Gastroenterol. 1994 Oct;89(10):1844-8.
Barrett's esophagus is a metaplastic condition resulting from gastroesophageal reflux disease. Previous medical and surgical therapies have failed to predictably eradicate Barrett's. The objective of this study was to assess the impact of long-term, high-dose lansoprazole, a proton pump inhibitor, on Barrett's esophagus.
Patients with Barrett's esophagus at least 3 cm long and with specialized columnar epithelium were treated with 60 mg of lansoprazole each morning. Every 6 months, patients had standardized symptomatic, laboratory, and endoscopic assessment. The length of Barrett's esophagus was measured, photo-documented, and biopsied.
Twenty-seven patients with Barrett's esophagus have been treated an average of 2.9 yr. Symptoms improved (70%, 19 patients), and erosive esophagitis healed (100%, 13 patients), but there was no significant reduction in the length of Barrett's epithelium (mean length at baseline 5.7 cm, final visit 5.3 cm). However, by the final visit, 20 of 26 patients (77%) had squamous islands: two unchanged in size, six with increased surface area, and 12 newly developed on therapy. Initially, mean fasting gastrin levels rose significantly but then plateaued after 1 month of therapy. Of 10 patients with gastrin levels for 18 months or longer, only one had a level > or = 400 pg/ml.
Lansoprazole 60 mg for up to 3 yr was safe and effective in controlling symptoms and esophagitis. The impact on the extent of Barrett's esophagus over this time interval was manifested by the extension and development of squamous islands.
巴雷特食管是一种由胃食管反流病导致的化生状态。既往的内科和外科治疗均未能可预测地根除巴雷特食管。本研究的目的是评估长期、高剂量质子泵抑制剂兰索拉唑对巴雷特食管的影响。
巴雷特食管长度至少3 cm且有特殊柱状上皮的患者，每天早晨服用60 mg兰索拉唑。每6个月，患者接受标准化的症状、实验室及内镜评估。测量巴雷特食管的长度，拍照记录并进行活检。
27例巴雷特食管患者平均接受了2.9年的治疗。症状改善（70%，19例患者），糜烂性食管炎愈合（100%，13例患者），但巴雷特上皮的长度无显著缩短（基线平均长度5.7 cm，末次随访时5.3 cm）。然而，在末次随访时，26例患者中有20例（77%）出现了鳞状上皮岛：2例大小未变，6例表面积增加，12例在治疗过程中新出现。最初，空腹胃泌素水平显著升高，但在治疗1个月后趋于平稳。在胃泌素水平监测18个月或更长时间的10例患者中，只有1例水平≥400 pg/ml。
60 mg兰索拉唑治疗长达3年在控制症状和食管炎方面安全有效。在此时间段内对巴雷特食管范围的影响表现为鳞状上皮岛的扩展和形成。
