Barrett's ulcer and treatment with cimetidine

Of seven patients with Barrett's esophagus, two had acute upper gastrointestinal (GI) tract bleeding, two had slow chronic upper GI tract bleeding; and three had dysphagia and weight loss. At upper GI tract endoscopy, 1- to 2-cm ulcers were seen in all seven patients in the distal esophagus. Four of the seven patients also had stricture of varying severity in the distal esophagus. Serial esophageal mucosal biopsy specimens in all seven patients revealed specialized columnar epithelium distal to 28 cm from the incisor teeth. Five of the seven patients were treated with intensive antacid therapy for eight weeks; but the ulcers had not healed after this period of treatment as assessed endoscopically. These five patients and two more then started therapy with cimetidine, 1.2 g per day. Repeat endoscopy four weeks and eight weeks after institution of cimetidine therapy revealed complete healing of the esophageal ulcers in six of the seven patients. One patient needed 16 weeks of cimetidine therapy before his ulcer had healed completely. Cimetidine therapy was not effective in preventing restricture of the esophagus. Two patients underwent biopsy 18 months after successful treatment; gastric epithelium had not reverted to squamous epithelium.