TOES Evaluations of Abstracts Submitted for the 69th Annual Scientific Meeting of the American College of Gastroenterology
American Journal of Gastroenterology, Vol. 99, No. 10, Suppl., 2004, ©2004 by Am. Coll. of Gastroenterology, ISSN 0002-9270/04/xx.xx, Published by Blackwell Publishing
October 29–November 3, 2004, Orlando, Florida
EFFECT OF ESOMEPRAZOLE ON INTRAESOPHAGEAL pH IN
PATIENTS WITH BARRETT’S ESOPHAGUS
Spechler S, et al. Am J Gastro 2004:99 Suppl; A46.
Evidence-based info: A prospective, randomized cross-over non blinded trial.
Type of Study: Marketing AstraZeneca
Sample size: n = 31
Background: In patients with Barrett’s esophagus it is all about controlling pH. A general goal is to NOT let the esophageal pH drop to less than 4 for more than an hour.
The better the pH control the less likely the Barrett’s advances or so it is thought.
This study looked at Nexium® 40mg bid vs. 20mg tid vs. 40 mg tid
Primary finding: see table
Nexium® 40 mg bid vs. Nexium® 20 mg tid vs. Nexium® 40 mg tid
% Patients with pH < 4 for > 1hr |
29% (9/31) |
22.6% (7/31) |
19.4% (6/31) |
Score of Study (TOES): = 75 out of 100
Is it consistent with what we already know? - Yes
How should this effect your practice?
- Even really large doses of Nexium® given often isn’t good enough to keep two to three of 10 patients with Barrett’s from staying in a dangerous zone with regard to disease progression.
- This does also show that the more often you dose a delayed release PPI the better the esophageal pH control.