Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
Purpose: To evaluate the therapeutic effect of high dose Proton Pump Inhibitors (PPI's) in the regression of specialized intestinal metaplasia of the distal esophagus (Barrett's Esophagus = BE).
Methods: I reported(Vol. 93, No. 9, Suppl., 2003) on five consecutive cases of endoscopically biopsy confirmed BE that had regressed to “no BE identified” at yearly surveillance endoscopy. I now have identified five more similarly treated cases. Patients were treated with high dose PPI to the end point of total supression of atypical, extraluminal, supraesophageal GERD signs and symptoms. Patients were encouraged to abstain from caffeine, mints and fatty foods. Weight loss was encouraged as was elevating the head of the bed, sleeping on the left side and avoidance of late evening meals. All patients took PPI's in doseage range of 160 mg to 360 mg daily titrated to total symptom supression.
Results: At follow up endoscopy all 5 patients who had previously demonstrated specialized intestinal metaplasia were symptomatically improved. They had biopsy results that were free of any evidence of histiologic BE. Four of the five patients have been diagnosed with Obstructive Sleep Apnea Syndrome(OSAS).
Conclusions: Barrett's Esophagus can regress with high dose Proton Pump Inhibitor therapy and lifestyle alterations when the end point of therapy is total supression of extraluminal, atypical GERD symptoms. OSAS is commonly encountered in GERD patients.