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 language | English |
|---|---|
| Pages (from-to) | 7-15 |
| Number of pages | 9 |
| Journal | Journal of Gastrointestinal Surgery |
| Volume | 16 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 2012 |
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Keywords
- Barrett's esophagus
- Fundoplication
- GERD
- PPI
ASJC Scopus subject areas
- Surgery
- Gastroenterology
Cite this
Long-Term Follow-up of Barrett's Epithelium : Medical Versus Antireflux Surgical Therapy. / Zaninotto, Giovanni; Parente, Paola; Salvador, Renato; Farinati, Fabio; Tieppo, Chiara; Passuello, Nicola; Zanatta, Lisa; Fassan, Matteo; Cavallin, Francesco; Costantini, Mario; Mescoli, Claudia; Battaglia, Giorgio; Ruol, Alberto; Ancona, Ermanno; Rugge, Massimo.
In: Journal of Gastrointestinal Surgery, Vol. 16, No. 1, 01.2012, p. 7-15.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Long-Term Follow-up of Barrett's Epithelium
T2 - Medical Versus Antireflux Surgical Therapy
AU - Zaninotto, Giovanni
AU - Parente, Paola
AU - Salvador, Renato
AU - Farinati, Fabio
AU - Tieppo, Chiara
AU - Passuello, Nicola
AU - Zanatta, Lisa
AU - Fassan, Matteo
AU - Cavallin, Francesco
AU - Costantini, Mario
AU - Mescoli, Claudia
AU - Battaglia, Giorgio
AU - Ruol, Alberto
AU - Ancona, Ermanno
AU - Rugge, Massimo
PY - 2012/1
Y1 - 2012/1
N2 - 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.
AB - 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.
KW - Barrett's esophagus
KW - Fundoplication
KW - GERD
KW - PPI
UR - http://www.scopus.com/inward/record.url?scp=84855346753&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84855346753&partnerID=8YFLogxK
U2 - 10.1007/s11605-011-1739-8
DO - 10.1007/s11605-011-1739-8
M3 - Article
VL - 16
SP - 7
EP - 15
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
IS - 1
ER -