On-demand PPI Therapy is Effective on Controlling Symptoms in Patients With Barrett's Esophagus.

The Impacts of On-demand Versus Continuous Esomeprazole Therapy on the Symptom Control and Histological Changes of Metaplastic Esophageal Epithelium in Patients With Barrett's Esophagus (EsoBE) - a Multicentre Randomized Controlled Trial

On-demand PPI therapy is feasible for the long-term treatment of patients with Barrett's esophagus.

Consecutive patients with symptomatic Barrett's esophagus are recruited and receive biopsy for esophageal metaplastic mucosa and gastric mucosa over the antrum and body during endoscopy on enrollment. The biopsy protocol for esophageal metaplastic mucosa is following Seattle protocol. GERD Q score will be conducted on enrollment. Additionally, blood sampling for CYP2C19 genotyping is also conducted on enrollment. The eligible subjects will be treated by 8-week esomeprazole, and are then randomly assigned to receive either maintenance or on-demand esomeprazole therapy (40 mg q.d.) for 40 weeks. The patients were asked to come back every four weeks for the recording of symptom days and PPI tablet consumption numbers. Follow-up endoscopy with biopsy for esophageal and gastric mucosa is performed at the end of the 48th weeks. We will compare the effects of maintenance and on-demand PPI therapy on (1) histological changes of esophageal metaplastic mucosa (2) symptom control (3) tablet consumption number

Inclusion Criteria:

• patients between the ages of 20 and 80 years
• having symptoms of acid regurgitation, heart burn, or feeling of acidity in the stomach
• having Barrett's Esophagus proven by histology confirmation
• length of esophageal metaplastic mucosa equal to or longer than 1 centimeter

Exclusion Criteria:

• pregnancy,
• coexistence of serious concomitant illness (for example, decompensated liver cirrhosis and uremia)
• previous gastric surgery,
• allergic to esomeprazole,
• presence of dysplastic esophageal mucosa
• equivocal endoscopic diagnosis of Barrett's esophagus