Efficacy in intra-oesophageal acid suppression may decrease after 2-year continuous treatment with proton pump inhibitors

Dig Liver Dis. 2007 May;39(5):415-21. doi: 10.1016/j.dld.2007.01.023. Epub 2007 Mar 26.


Background: Long-term intra-oesophageal acid suppression with proton pump inhibitors represents a management option for Barrett's oesophagus and severe reflux oesophagitis, but its stability over time has not been adequately assessed.

Aim: Our aim was to evaluate prospectively the efficacy of proton pump inhibitors in suppressing intra-oesophageal acidity after 2-year continuous treatment.

Methods: Forty-five patients with Barrett's oesophagus or severe reflux oesophagitis on a proton pump inhibitor regimen (once or twice daily) that normalised the total percentage acid exposure time were re-evaluated by means of 24-h oesophageal pH-monitoring after 2-year of continuous unmodified treatment.

Results: A significant rise in the total percentage acid exposure time was observed at 2-year follow-up (P=0.029), owing to an increased value in 27 (60%) cases (9 on a twice daily regimen), higher than normal in 10 of them (22% of the whole group) (3 on a twice daily regimen). In 18 patients (40%) the total percentage acid exposure time was stable or decreased. Heartburn remained efficiently suppressed in all patients.

Conclusions: The efficacy of proton pump inhibitors in suppressing intra-oesophageal acidity during continuous treatment may decrease over time, up to abnormal levels of oesophageal acid exposure in a minority of cases. This may occur without heartburn recurrence and with both once and twice daily regimens.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Barrett Esophagus / drug therapy*
  • Drug Tolerance*
  • Enzyme Inhibitors / pharmacology
  • Enzyme Inhibitors / therapeutic use*
  • Esophagitis, Peptic / drug therapy*
  • Female
  • Humans
  • Hydrogen-Ion Concentration / drug effects
  • Male
  • Middle Aged
  • Prospective Studies
  • Proton Pump Inhibitors*
  • Time Factors
  • Treatment Outcome


  • Enzyme Inhibitors
  • Proton Pump Inhibitors