Prolonged cimetidine therapy in ulcerated Barrett's columnar-lined esophagus

In a 77-year-old man with dysphagia, x-rays demonstrated an irregular stenotic process in the lower third of the esophagus, suggesting malignancy. Endoscopy disclosed moderate narrowing of the lumen and several ulcers separated by bulges. Serial biopsies revealed Barrett's mucosa. Cimetidine 1 g/day led to prompt improvement and endoscopically there was a disappearance of the lesions after 3 months of therapy. Reduction of the drug to 400 mg/day 3 months later with supplements of antacids and metoclopramide was followed by reappearance of symptoms and recurrence of a deep ulcer. Raising the dose of cimetidine to 1 g/day again resulted in healing and since then a maintenance dose of 600 mg cimetidine with antacids and metoclopramide has been successful in preventing recurrence. This long-term study in a patient with Barrett's esophagus showed 1) that cimetidine can be effective in treating such patients; 2) the prophylactic value of multitherapy as a maintenance regimen, and 3) the importance of careful follow-up.