The factors predisposing to the development of Barrett's esophagus in patients with gastroesophageal reflux disease are unclear. We compared symptoms, esophageal acid and alkaline exposure (pH <2, < 3, <4 and > 7), lower esophageal sphincter function, and circadian esophageal motor activity in 15 patients with Barrett's esophagus to 24 patients with esophagitis, and 25 normal volunteers. Compared to patients with esophagitis, patients with Barrett's esophagus had less heartburn and regurgitation, hut an increased frequency and duration of reflux episodes, and % time pH < 2, < 3, <4 and pH > 7 on ambulatory 24-hour esophageal pH monitoring. This was associated with an increased prevalence of a mechanically defective lower esophageal sphincter and a decreased mean contraction amplitude in the distal esophagus on standard manometry and an increased frequency of non-peristaltic contraction and low amplitude contractions (< 30mmHg) on 24-hour ambulatory esophageal motility monitoring. These data show that despite less symptoms patients with Barrett's esophagus have a markedly increased esophageal acid and alkaline exposure compared to patients with esophagitis. This appears to be due to persistent reflux of gastric and duodenal contents across a mechanically defective lower esophageal sphincter and inefficient esophageal clearance function.
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Stein et al. (1992) studied this question.