Long-Term Follow-up of Barrett's Epithelium: Medical Versus Antireflux Surgical Therapy

Giovanni Zaninotto, Paola Parente, Renato Salvador, Fabio Farinati, Chiara Tieppo, Nicola Passuello, Lisa Zanatta, Matteo Fassan, Francesco Cavallin, Mario Costantini, Claudia Mescoli, Giorgio Battaglia, Alberto Ruol, Ermanno Ancona, Massimo Rugge

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Barrett's esophagus (BE) is the most serious complication of GERD. In BE patients, this observational study compares the effects of antireflux surgery versus antisecretory medical therapy. Methods: Overall, 89 BE patients (long BE = 45; short BE = 44) were considered: 45 patients underwent antireflux surgery and 44 underwent medical therapy. At both initial and follow-up endoscopy, symptoms were assessed using a detailed questionnaire; BE phenotypic changes [intestinal metaplasia (IM) presence/type, Cdx2 expression] were assessed by histology (H&E), histochemistry (HID), and immunohistochemistry. Surgical failures were defined as follows: (1) abnormal 24-h pH monitoring results after surgery, (2) endoscopically evident recurrent esophagitis, and (3) recurrent hiatal hernia or slipped fundoplication on endoscopy or barium swallow. Results: Reversion of IM was observed in 12/44 SSBE and 0/45 LSBE patients (p <0. 01). Reversion was more frequently observed after effective antireflux surgery than after medical treatment (p = 0. 04). In patients with no further evidence of IM after therapy, Cdx2 expression was also absent (p = 0. 02). The extent of IM was reduced, and the IM phenotype improved in SSBE patients after surgery. Conclusions: Patients with short BE (but not those with long BE) may benefit from surgically reducing the esophagus' exposure to GE reflux; among these patients, successful surgery carries a higher IM reversion rate than medical treatment.

Original languageEnglish
Pages (from-to)7-15
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume16
Issue number1
DOIs
Publication statusPublished - Jan 2012

Keywords

  • Barrett's esophagus
  • Fundoplication
  • GERD
  • PPI

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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