Katzka D A, Castell D O
Department of Medicine, Graduate Hospital, Philadelphia, Pennsylvania.
Am J Gastroenterol. 1994 Jul;89(7):989-91.
Patients with Barrett's metaplasia of the esophagus often lack the appropriate amount of heartburn for their severity of gastroesophageal reflux. Therefore, we studied patients with Barrett's metaplasia by prolonged ambulatory pH monitoring after completely suppressing their heartburn symptoms to determine whether acid reflux was underestimated in symptom assessment.
Five patients with Barrett's esophagus, all of whom presented with heartburn, were treated with omeprazole (20-60 mg/day) until they were asymptomatic. Twenty-four-hour pH ambulatory monitoring was performed while they were on omeprazole.
Four of five patients showed persistent abnormal gastroesophageal reflux after treatment with omeprazole. Two patients showed abnormally increased supine reflux and two patients had an abnormal increase in both supine and upright reflux. Only one patient had complete inhibition of the acid reflux by the omeprazole (20 mg b.i.d.).
Treating the patient with Barrett's esophagus to the endpoint of eradication of heartburn does not insure adequate control of acid reflux. Prolonged ambulatory pH monitoring of the esophagus should be conducted to demonstrate that an adequate dose of omeprazole has been given, despite symptomatic improvement.
食管巴雷特化生患者的胃食管反流严重程度往往与烧心症状的程度不匹配。因此，我们对巴雷特化生患者在完全抑制烧心症状后进行长时间动态pH监测，以确定在症状评估中酸反流是否被低估。
5例均有烧心症状的巴雷特食管患者接受奥美拉唑（20 - 60毫克/天）治疗直至无症状。在服用奥美拉唑期间进行24小时动态pH监测。
5例患者中有4例在接受奥美拉唑治疗后仍存在持续异常的胃食管反流。2例患者仰卧位反流异常增加，2例患者仰卧位和直立位反流均异常增加。只有1例患者的酸反流被奥美拉唑（20毫克，每日两次）完全抑制。
将巴雷特食管患者的烧心症状治疗至消除终点并不能确保充分控制酸反流。尽管症状有所改善，仍应进行食管长时间动态pH监测，以证明已给予足够剂量的奥美拉唑。
