Does Intensive Acid Suppression Reduce Esophageal Inflammation and Recurrent Barrett's Esophagus Following Ablation?

Patients who achieve complete remission of intestinal metaplasia following ablation will be
randomized (using concealed allocation, like the flip of a coin) to either intensive acid
suppression with dexlansoprazole 60-90 mg/day or to symptom guided acid suppression with
escalating doses of omeprazole (20-60 mg/day) for 6 months. Control of reflux will be
assessed using 24 hour ambulatory pH monitoring. The need to escalate drug dosage at the 3
month visit will be determined by presence of excessive acid exposure on ambulatory pH
monitoring. Biopsies of esophageal tissue will be obtained at baseline, then at 3 months and
6 months following randomization to measure changes in inflammatory biomarkers.

Patients who have undergone ablation for Barrett's Esophagus (BE) and High Grade Dysplasia
(HGD) or Low Grade Dysplasia (LGD) with Photodynamic Therapy (PDT)/Radiofrequency ablation
and endoscopic mucosal resection who have no endoscopic and histologic evidence of
specialized intestinal metaplasia on biopsies from the esophagus on two successive
endoscopies post ablation will be offered enrollment in the study.

Inclusion criteria:

1. Absence of intestinal metaplasia on endoscopy (under Narrow Band Imaging) and on
histology (from biopsies taken from gastroesophageal junction and distal esophagus)
on two successive surveillance endoscopies.

2. Able to consent to study

3. Males and females age 18-90

4. Life expectancy of 5 years or greater.

Exclusion criteria:

1. Pregnancy

2. Inability to consent for the procedure

3. Anticoagulation therapy precluding performance of ambulatory pH monitoring and/or
biopsies

4. Intolerance to proton pump inhibitors

5. Elevation in Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), (liver
enzymes), bilirubin or alkaline phosphatase more than five times the upper limit of
normal.