I read with interest the article "Clinical Implications of Barrett's Esophagus" by Crooks and Lichtenstein1 in the Archives. In the "Medical Therapy of Barrett's Esophagus" section, the authors comment, "It is unclear whether it is necessary or desirable to make all patients with Barrett's esophagus achlorhydric, which is now possible with the use of proton pump inhibitors." I believe what the authors intend to imply is that it is possible to increase the intraesophageal pH level to above 4 for longer periods in patients treated with proton pump inhibition, but the use of proton pump inhibitors, even in large doses, will not render most patients truly achlorhydric over a given 24-hour period.
Crooks and Lichtenstein correctly point out that there were no data to suggest whether maintaining intraesophageal pH above 4 allows reversion of Barrett's epithelium to squamous epithelium to occur more readily. However, in a recent survey involving