CORRELATION BETWEEN BASAL ACID OUTPUT AND DAILY RANITIDINE DOSE REQUIRED FOR THERAPY IN BARRETTS-ESOPHAGUS

We prospectively evaluated basal gastric acid secretion in 42 consecutive patients with Barrett's esophagus to determine the optimal dose requirement for an H-2-receptor antagonist in relation to the gastric acid secretory status of each patient. All patients with Barrett's esophagus had pyrosis and 31 of the 42 patients had erosive esophagitis. Mean extension of Barrett's epithelium was 6.9 cm (range 2-17 cm). Mean basal acid output for the patients with Barrett's esophagus was 8.0 +/- 5.2 meq/hr, which was significantly different compared to a group of 65 normal subjects with mean basal acid output of 3.0 +/- 2.7 meq/hr (P < 0.001). There was no correlation between basal acid output and extension of Barrett's epithelium. All patients with Barrett's esophagus were treated with ranitidine, with 24 requiring standard-dose (300 mg/day) and 18 requiring increased doses (mean 1170 mg/day, range 600-2400 mg/day) for complete healing of esophagitis and disappearance of pyrosis. There was a significant correlation between basal acid output and daily ranitidine dose required for therapy (r = 0.52, P < 0.001). Fifteen of the 42 patients with Barrett's esophagus (36%) had gastric acid hypersecretion. There was a significant association between gastric acid hypersecretion defined as a basal acid output of greater than 10.0 meq/hr and a requirement for increased daily ranitidine doses (greater than 300 mg/day) (P < 0.0002). No side effects occurred with any of these high doses of ranitidine. We conclude that as a group, patients with Barrett's esophagus have significantly higher basal acid outputs than normal subjects and many require increased therapeutic doses of ranitidine. Furthermore, there is a significant correlation between basal acid output and therapeutic daily ranitidine dose and a significant association between gastric acid hypersecretion and the requirement for increased daily ranitidine doses.