Cooper B T, Neumann C S, Cox M A, Iqbal T H
Gastroenterology Unit, City Hospital, Birmingham, UK.
Aliment Pharmacol Ther. 1998 Sep;12(9):893-7. doi: 10.1046/j.1365-2036.1998.00389.x.
Because of the malignant potential of Barrett's oesophagus, an aim of treatment is to cause the columnar epithelium to regress. A logical approach is to decrease acid reflux which is an important aetiological factor in Barrett's oesophagus. Treatment with omeprazole 20-80 mg over 1-3 years has yielded conflicting but largely disappointing results.
To determine if treatment of Barrett's oesophagus with omeprazole 20 mg daily for up to 6 years can cause regression of the Barrett's epithelium.
Forty-seven patients with Barrett's oesophagus were treated in an open prospective study. Nine patients were treated for 2 years, 12 for 3 years, 10 for 4 years, eight for 5 years and eight for 6 years. Patients were endoscoped at 1-2-year intervals and endoscoped at the end of the treatment period.
No significant shortening of the length of the Barrett's segment was seen during any treatment period, although omeprazole controlled reflux symptoms and was well tolerated. Macroscopic squamous islands appeared in 55% of patients, mostly in the first 2-3 years although in five patients they appeared later in treatment.
Treatment of Barrett's oesophagus with omeprazole 20 mg daily for periods of up to 6 years did not cause regression in the length of the Barrett's segment, but it did lead in over half of the patients to partial re-epithelialization in the form of squamous islands.
由于巴雷特食管具有恶变潜能，治疗的目标是使柱状上皮消退。一种合理的方法是减少胃酸反流，胃酸反流是巴雷特食管的一个重要病因。使用20 - 80毫克奥美拉唑治疗1 - 3年，结果相互矛盾且大多令人失望。
确定每日服用20毫克奥美拉唑治疗巴雷特食管长达6年是否能使巴雷特上皮消退。
在一项开放性前瞻性研究中对47例巴雷特食管患者进行治疗。9例患者治疗2年，12例治疗3年，10例治疗4年，8例治疗5年，8例治疗6年。患者每隔1 - 2年接受一次内镜检查，并在治疗期结束时进行内镜检查。
在任何治疗期间，均未观察到巴雷特段长度有明显缩短，尽管奥美拉唑可控制反流症状且耐受性良好。55%的患者出现肉眼可见的鳞状上皮岛，大多在最初2 - 3年出现，不过有5例患者在治疗后期出现。
每日服用20毫克奥美拉唑治疗巴雷特食管长达6年，并未使巴雷特段长度消退，但导致超过半数患者出现鳞状上皮岛形式的部分重新上皮化。
