Total acid suppression and its effect on Barrett's esophagus

Barrett's esophagus is a complication of gastroesophageal reflux disease (GERD) and may result from prolonged acid exposure in the esophagus. As a result, clinicians are investigating a possible relationship between acid suppression and a decrease in the risk of Barrett's esophagus progression. Some studies suggest that the length of Barrett's esophagus may be reduced with total acid suppression therapy. Other studies indicate that patients with Barrett's esophagus are less sensitive to acid-induced symptoms (e.g., heartburn). While these patients may feel better symptomatically, the acid may not be sufficiently reduced to prohibit further damage. Acid suppression, even on high-dose pharmacotherapy, does not always eliminate the nocturnal acid breakthroughs. The contrasting study results on this issue are discussed.