I have documented eighteen cases of patients who no longer demonstrate intestinal metaplasia on repeat or surviellience endoscopy of the esophagus. Several of these individuals have had more than one biopsy negative surviellence endoscopy . Sixteen of these case biopsy specimans have been confirmed at the University of Michigan. Two situations had no biopsy speciman obtained since the esophagus was determined to be normal at endoscopy. All cases are considered short segment. I have published fifteen of the cases in the American Journal of Gastroenterology*. The intensity of therapy was quite variable in regard to the dose of antisecretory therapy utilized. It is apparent the response of the person to the therapy for GERD needs to be carefully monitored with the intent of adjusting or titrating the intensity of therapy to achieve a desired response. It is perfectly clear that the doseage of antisecretory therapy varies rather dramatically among individuals. I site Dr. Donald Castell in my published cases. He documented greater than six fold patient to patient bioavailability of omeprazole in clinical studies.
Numerous surveys document the inadequate resolution of symptoms in the majority of GERD
patients DESPITE BEING ON PRESCRIPTION MEDICATIONS! This demonstrates poor understanding and imperfect management of this illness.