In the associated editorial the authors consider the results and in particular the effects of using high-dose PPI (esomeprazole 40mg twice daily ) over low-dose PPI (esomeprazole 20mg once daily). It is noted that the addition of aspirin increased the effect but aspirin alone was not associated with improved outcomes, so high-dose PPI plus aspirin was shown to have the strongest overall effect. The authors also discuss the dose of aspirin used in this study (300mg daily) and note that it is higher than the dose usually used for preventative therapy (75mg daily). They speculate that the lower dose may have reduced the 1% prevalence of serious adverse events seen in this study. Overall these authors feel that the results of this trial are rather convincing and that future guidelines will now need to consider whether the notion of the lowest possible PPI dose to control symptoms still applies and whether high-dose PPIs should now be used routinely as prophylaxis in Barrett's oesophagus.