• A Abu-Sneineh, W Tam, M Schoeman, R Fraser, A R Ruszkiewicz, E Smith, P A Drew, J Dent, and R H Holloway.
• Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, SA, Australia.
• Aliment. Pharmacol. Ther. 2010 Oct 1; 32 (8): 1023-30.

BackgroundAcid reflux is often difficult to control medically.AimTo assess the effect of 40 mg twice daily esomeprazole (high-dose) on gastric and oesophageal pH and symptoms, and biomarkers relevant to adenocarcinoma, in patients with Barrett's oesophagus (BO).MethodsEighteen patients, treated with proton pump inhibitors as prescribed by their treating doctor, had their therapy increased to high-dose esomeprazole for 6 months.ResultsAt entry into the study, 9/18 patients had excessive 24-h oesophageal acid exposure, and gastric pH remained <4 for >16 h in 8/18. With high-dose esomeprazole, excessive acid exposure occurred in 2/18 patients, and gastric pH <4 was decreased from 38% of overall recording time and 53% of the nocturnal period to 15% and 17%, respectively (P < 0.001). There was a reduction in self-assessed symptoms of heartburn (P = 0.0005) and regurgitation (P < 0.0001), and inflammation and proliferation in the Barrett's mucosa. There was no significant change in p53, MGMT or COX-2 expression, or in aberrant DNA methylation.ConclusionsHigh-dose esomeprazole achieved higher levels of gastric acid suppression and control of oesophageal acid reflux and symptoms, with significant decreases in inflammation and epithelial proliferation. There was no reversal of aberrant DNA methylation.© 2010 Blackwell Publishing Ltd.

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