PPI Dosing in Non-Dysplastic Barrett Esophagus

In patients with non-dysplastic Barrett esophagus, what regimen of proton pump inhibitors (PPI) should be initially prescribed for management?


A. Once daily, 30-60 minutes before breakfast
B. Twice daily, 30-60 minutes before breakfast and before dinner
C. Given lack of dysplasia, no PPI is necessary
D. PPI use should be based on 24-hour pH testing
 

ANSWER: A

The role of PPIs in Barrett esophagus is to control symptoms. Whether acid suppressants have a chemotherapeutic role in preventing progression of dysplasia is controversial. Therefore, the regimen should be the lowest effective dose that controls symptoms. Most patients respond to once-daily dosing. If symptoms persist, increasing to twice daily or titrating dosage based on pH studies are both options.