Is endoscopy helpful in patient monitoring?

The safety issues involved in patients on long-term treatment with omeprazole will determine whether endoscopic monitoring is necessary. In a review of 646 patients who have undergone regular gastric biopsies during continuous treatment with omeprazole, 10-120 mg daily, for periods of up to 5.5 years, there were no overall patterns to the changes in gastric endocrine cells. Apparent gastric endocrine cell hyperplasia in 72% of patients correlated with the development of chronic atrophic corpus gastritis. The only macroscopic changes to be reported were endocrine tumours in 4 out of 184 patients on long-term omeprazole for Zollinger-Ellison syndrome, and at least 3 of these patients had multiple endocrine neoplasia (MEN) type 1 syndrome. In patients with other low acid states, such as pernicious anaemia or after gastric irradiation or gastric surgery, in which drug therapy is not a confounding factor, there is a very low risk of developing macroscopic lesions within the stomach, and endoscopic surveillance is not routine practice. In conclusion, upper gastrointestinal endoscopic monitoring to identify microscopic or macroscopic changes cannot be justified during at least the first 5 years of continuous treatment with omeprazole.