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Efficacy in intra-oesophageal acid suppression may decrease after 2-year continuous treatment with proton pump

M Frazzoni1, M Manno, E De Micheli

  • 1Internal Medicine and Gastroenterology Unit, New S. Agostino Hospital, Viale Giardini 1355, 41100 Modena, Italy. m.frazzoni@ausl.mo.it

Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
|March 24, 2007
PubMed
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Proton pump inhibitor efficacy for acid suppression may decline over two years in patients with Barrett's esophagus or severe reflux esophagitis. This can lead to increased acid exposure, even without heartburn recurrence.

Area of Science:

  • Gastroenterology
  • Pharmacology

Background:

  • Proton pump inhibitors (PPIs) are used for long-term acid suppression in Barrett's esophagus and severe reflux esophagitis.
  • The long-term stability of PPI efficacy in these conditions is not well-established.

Purpose of the Study:

  • To prospectively assess the efficacy of PPIs in suppressing intra-esophageal acidity after two years of continuous treatment.

Main Methods:

  • 45 patients with Barrett's esophagus or severe reflux esophagitis on PPIs underwent 24-hour esophageal pH-monitoring.
  • Patients were re-evaluated after two years of continuous, unmodified PPI treatment (once or twice daily).

Main Results:

  • A significant increase in total percentage acid exposure time was observed at two-year follow-up (P=0.029).

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  • 60% of patients showed increased acid exposure, with 22% exceeding normal levels.
  • Heartburn remained suppressed in all patients, irrespective of acid exposure changes.

    • Conclusions:

    • PPI efficacy in suppressing intra-esophageal acidity may diminish with prolonged continuous use.
    • Abnormal esophageal acid exposure can occur in a minority of patients over time, even without recurrent heartburn symptoms.
    • This decrease in efficacy was observed with both once and twice daily PPI regimens.