Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
Purpose: The aim of this study was to evaluate the esophageal and gastric findings in patients with Barrett's esophagus on long term PPI therapy in our center
Methods: 61 patients with biopsy proven Barrett's esophagus on continuous PPI therapy have been followed as follows: 2 for 16 years, 18 for 15 years, 30 for 14 years, 2 for 13 years, 6 for 12 years, 3 for 11 years. Initially omeprazole was used on alternate days because of the “black box” warning. Thereafter, 53 patients are maintained on a daily dose of PPI (Omeprazole 20 mg or esomeprazole 40 mg twice daily in 27 patients and once daily in 26 patients). 8 patients remained on an alternate day regime. Surveillance endoscopies (3 months to 2 years) with esophageal and gastric biopsies have been performed in all.
Results: Non-Esophagogatric Events: 7 patients (11.5%) have died from non-esophagogastric causes and 17 (28%) have developed unrelated diseases.
Esophagogastric Findings: Esophageal- one patient with once daily dose of PPI developed high grade dysplasia (1.7%) after 5 years of follow up, but refused surgery and has remained on endoscopic follow up. Another patient had low grade dysplasia on biopsy, remained on twice daily PPI and repeat biopsies are consistently negative for dysplasia. 4 patients had recurrent grade B or C esophagitis that responded to an increased dose of PPI.
Gastric −20 patients (30%) developed gastric fundic polyps (2 to more than 100) after more than 2 years of PPI therapy. One patient developed a large (3 × 3 cm) adenomatous polyp with severe dysplasia requiring endoscopic resection and follow up did not show recurrence.
Conclusions: A single center 12–15 year (cumulative 853 person-years) prospective follow up of patients with Barrett's esophagus on continuous PPI therapy revealed very low incidence of dysplasia (one case) and no carcinoma. Gastric polyps are common on PPI therapy and one patient had high grade dysplastic gastric adenoma. The high mortality and morbidity (39.5% in this group) from unrelated causes in patients with Barrett's esophagus favour a conservative approach; however, continued surveillance of both esophageal and gastric status would seem prudent on long term PPI therapy.