MANAGEMENT OF BARRETT'S ESOPHAGUS - CME Conferences

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3 rd Annual Essentials in Primary CareSummer Conference: Session 1Thursday, July 26, 2012GASTRIC ACID CONTROL IN BARRETT’SDoes acid control affect length of metaplasticepithelium?BARRETT’S ESOPHAGUSMaximal acid control (titrate with pH monitor)• 9 patients (8 male; age 44-72yrs)• Follow up 13-118 months (median 37)• Rx:PPI BID (2)PPI BID + ranitidine (7)• Linear regression: 9/9 (1-3 cm)• Squamous islands: 5/9(Srinivasan R, et al: Aliment Pharmacol Ther 15:519, 2001)Donald Castell, MDManagement of Barrett’s Esophagus
3 rd Annual Essentials in Primary CareSummer Conference: Session 1Thursday, July 26, 2012REGRESSION OF BARRETT’S WITHOMEPRAZOLE• 53 patients with BE randomized prospectively.27: ranitidine 150 mg bid26: omeprazole 40 mg bid• Symptoms controlled for 24 months• 24 hr pH at 3 months (mean and 95% CI)ranitidine: 9.4 (6.2 - 13.0)%omeprazole: 0.1 (0-1.2)%(Peters et al: Gut 45:489, 1999)RELATIVE CHANGES IN LENGTH ANDSURFACE AREA OF BARRETT’S ESOPHAGUS421-1OmeprazoleRanitidine% change (length)0-2-4% change (area)-3-5-6-7-83 9 15 24Time (months)-93 9 15 24Time (months)Peters, et al: Gut 1999;45:489-494Donald Castell, MDManagement of Barrett’s Esophagus
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MANAGEMENT OF BARRETT'S ESOPHAGUS - CME Conferences

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