Malesci A, Savarino V, Zentilin P, Belicchi M, Mela G S, Lapertosa G, Bocchia P, Ronchi G, Franceschi M
Università di Milano, Dipartimento di Medicina Interna, Italy.
Gastrointest Endosc. 1996 Dec;44(6):700-5. doi: 10.1016/s0016-5107(96)70055-x.
Barrett's esophagus is mainly regarded as an acquired condition related to increased gastroesophageal reflux. Thus it is conceivable that abolition of acid reflux would lead to its regression. The aim of this study was to assess whether long-term treatment with high-dose omeprazole (60 mg/day) produces a consistent control of gastric acid production and normalizes the esophageal acid exposure, thus reducing the length of Barrett's epithelium.
Fourteen patients (8 men and 6 women, mean age 52 years) with histologic diagnosis of columnar epithelium longer than 3 cm in the distal part of the esophagus were enrolled and began receiving 60 mg of omeprazole in a single daily morning dose. Before therapy and after 6 and 12 months of therapy, all patients had endoscopy with four-quadrant biopsies at 2 cm intervals. A 24-hour esophagogastric pH recording was performed at entry and after 10 days, 6 months, and 12 months of treatment in all patients.
The initial length of Barrett's epithelium (4.5 +/- 1.9 cm) was significantly reduced after 6 months (3.1 +/- 1.1; p < 0.01) and 12 months (2.1 +/- 1.6; p < 0.005) of treatment. Values were significantly lower at 12 than at 6 months (p < 0.03). The 24-hour mean gastric pH after 10 days (5.89 +/- 0.58), 6 months (5.71 +/- 0.55), and 12 months (5.54 +/- 0.76) of therapy was always higher (p < 0.001) than the basal level (1.9 +/- 0.49). No significant difference in gastric pH was seen over the treatment period. The 24-hour mean percent of time in which pH in the esophagus was below 4.0 decreased significantly (p < 0.001) from a basal rate of 29.4% to 3.5%, 3.0%, and 4.9% in the various time intervals of therapy. There was a normalization of esophageal acid exposure in all patients but two.
It can be concluded that the antisecretory effect of 60 mg/day of omeprazole is consistent and is kept constant throughout the entire 1-year treatment period. The consequent normalization of esophageal acid exposure in almost all patients in our series led to a partial, but significant, regression in the length of Barrett's epithelium.
巴雷特食管主要被视为一种与胃食管反流增加相关的后天性疾病。因此可以想象，消除胃酸反流会导致其消退。本研究的目的是评估高剂量奥美拉唑（60毫克/天）长期治疗是否能持续控制胃酸分泌并使食管酸暴露正常化，从而缩短巴雷特上皮的长度。
纳入14例患者（8例男性和6例女性，平均年龄52岁），其组织学诊断为食管远端柱状上皮长度超过3厘米，开始每日早晨单次服用60毫克奥美拉唑。在治疗前以及治疗6个月和12个月后，所有患者均接受内镜检查，并每隔2厘米进行四象限活检。所有患者在入组时以及治疗10天、6个月和12个月后进行24小时食管胃pH值记录。
治疗6个月（3.1±1.1厘米；p<0.01）和12个月（2.1±1.6厘米；p<0.005）后，巴雷特上皮的初始长度（4.5±1.9厘米）显著缩短。12个月时的值显著低于6个月时的值（p<0.03）。治疗10天（5.89±0.58）、6个月（5.71±0.55）和12个月（5.54±0.76）后的24小时平均胃pH值始终高于基础水平（1.9±0.49）（p<0.001）。在整个治疗期间，胃pH值无显著差异。食管pH值低于4.0的24小时平均时间百分比从基础率的29.4%显著降低（p<0.001），在治疗的不同时间段分别降至3.5%、3.0%和4.9%。除两名患者外，所有患者的食管酸暴露均正常化。
可以得出结论，每天60毫克奥美拉唑的抑酸作用是持续的，并且在整个1年的治疗期间保持不变。我们系列中几乎所有患者食管酸暴露的随之正常化导致巴雷特上皮长度部分但显著地缩短。
