**4.1 Progression of erosive esophagitis to BE**

Eighty-three patients (54% male, median age 59 years) with mild esophagitis were treated with continuous PPIs and cisapride at doses sufficient to control symptoms (**Table 3**) [25]. After 2 years, during the second "follow-up" endoscopy, 12 (15%) had developed BE histologically confirmed in the biopsies taken. Of these patients, nine


*GERD: Dmax = 0.25 > D (70:0.05) = 0.16 and P < 0.05. Dmax = 0.25 > D (70:0.01) = 0.19 and P < 0.01. BE: Dmax = 0.26 > D (50:0.05) = 0.19 and P < 0.05. Dmax = 0.26 > D (50:0.01) = 0.23 and P < 0.01.*

## **Table 5.**

*Comparison of the effect after PPI treatment of patients with BE and GERD.*

had short-segment disease (SSBE<3 cm) and the other three had long-segment BE (LSBE>3 cm).

Of great importance was the development of lower esophageal sphincter pressures (LOSPs) patients who developed BE, had significantly reduced LOSP compared to those who had not progressed, but their age and gender were not stated.

In another study by Isolauri et al. [26] 6 (or 12%) of 50 medically treated patients with GERD symptoms and abnormal pH values developed BE, defined as the presence of epithelial specialized columnar-intestinal histologically confirmed at least 3 cm. over the most proximal gastric fold, during a follow-up period of 17–22 years. Four of these patients had grade I esophagitis and two grade II esophagitis at index endoscopy (Savary-Miller classification). In this study, the distinguishing characteristics between those who developed and those who did not develop BE were not given. In an international, multicenter study of the use of maintenance omeprazole in patients with reflux esophagitis who were refractory to long-term histamine 2 receptor antagonist (H2RA) therapy, 20 of 166 patients (12%) developed BE during a median follow-up of 6.5 years (range: 1.4–11.2) [27]. All patients were taking omeprazole at all times, but dosage and demographic characteristics were not stated.

The study by McDougall et al. reported that 3 of 33 (9%) patients presenting with esophagitis developed BE, during a follow-up period of up to 4.5 years [28]. In terms of gender, all three patients were male. It was reported that a patient with minimal esophagitis and a small hiatus hernia at index endoscopy developed a 5-cm length of BE. But, from the anamnestic data, this patient was taking ranitidine 150 mg twice a day. Another patient had grade III esophagitis initially, which reverted to grade I at 2 months of H2RA but then developed a 5-cm segment of BE. This patient was also taking ranitidine 150 mg twice daily. The third patient with grade III esophagitis initially developed a 6 cm BE at his fourth endoscopy 18 months later, although this patient was started on omeprazole 20 mg daily after 12 months but despite this, BE was diagnosed.

In another study, patients with reflux esophagitis cured after PPI treatment continued with the maintenance dose for 14.6 months. Repeated endoscopy was repeated in those patients who had repeated symptoms [1]. Two patients developed BE; one of class II (Savary-Miller classification) after 24 months of follow-up and one of class III after 8 months. In this study, the length of BE and the fact which criteria were used for the diagnosis of BE are not given. These patients were part of a study of 692 patients with GERD, where more than half of the patients had esophageal reflux, but it is not known
