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Efficacy of medical therapy and antireflux surgery to prevent Barrett's metaplasia in patients with gastroesophageal reflux disease.

Abstract

OBJECTIVE

To investigate whether Barrett's metaplasia may develop despite effective medical therapy.

SUMMARY BACKGROUND DATA

Gastroesophageal reflux disease has a multifactorial etiology. Therefore, medical treatment may not prevent complications of reflux disease.

METHODS

Eighty-three patients with reflux disease and mild esophagitis were prospectively studied for the development of Barrett's metaplasia while receiving long-term therapy with proton pump inhibitors and cisapride. Only patients who had effective control of reflux symptoms and esophagitis were included. The surveillance time was 2 years. The outcome of these 83 patients was compared with that of 42 patients in whom antireflux surgery was performed with a median follow-up of 3.5 years.

RESULTS

Twelve (14.5%) patients developed Barrett's while receiving medical therapy; this was not seen after surgery. Patients developing Barrett's had a weaker lower esophageal sphincter and peristalsis before treatment than patients with uncomplicated disease.

CONCLUSIONS

Antireflux surgery is superior to medical therapy in the prevention of Barrett's metaplasia. Therefore, patients with reflux disease who have a weak lower esophageal sphincter and poor esophageal peristalsis should undergo antireflux surgery, even if they have only mild esophagitis.

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  • Authors+Show Affiliations

    ,

    Department of Surgery, University of Innsbruck, Innsbruck, Austria. gerold.wetscher@uklibk.ac.at

    , , , , , ,

    Source

    Annals of surgery 234:5 2001 Nov pg 627-32

    MeSH

    2-Pyridinylmethylsulfinylbenzimidazoles
    Adult
    Aged
    Anti-Ulcer Agents
    Barrett Esophagus
    Benzimidazoles
    Esophagitis, Peptic
    Esophagogastric Junction
    Esophagus
    Female
    Fundoplication
    Gastroesophageal Reflux
    Humans
    Male
    Manometry
    Metaplasia
    Middle Aged
    Mucous Membrane
    Omeprazole
    Pantoprazole
    Prospective Studies
    Sulfoxides

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    11685025

    Citation

    Wetscher, G J., et al. "Efficacy of Medical Therapy and Antireflux Surgery to Prevent Barrett's Metaplasia in Patients With Gastroesophageal Reflux Disease." Annals of Surgery, vol. 234, no. 5, 2001, pp. 627-32.
    Wetscher GJ, Gadenstaetter M, Klingler PJ, et al. Efficacy of medical therapy and antireflux surgery to prevent Barrett's metaplasia in patients with gastroesophageal reflux disease. Ann Surg. 2001;234(5):627-32.
    Wetscher, G. J., Gadenstaetter, M., Klingler, P. J., Weiss, H., Obrist, P., Wykypiel, H., ... Profanter, C. (2001). Efficacy of medical therapy and antireflux surgery to prevent Barrett's metaplasia in patients with gastroesophageal reflux disease. Annals of Surgery, 234(5), pp. 627-32.
    Wetscher GJ, et al. Efficacy of Medical Therapy and Antireflux Surgery to Prevent Barrett's Metaplasia in Patients With Gastroesophageal Reflux Disease. Ann Surg. 2001;234(5):627-32. PubMed PMID: 11685025.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Efficacy of medical therapy and antireflux surgery to prevent Barrett's metaplasia in patients with gastroesophageal reflux disease. AU - Wetscher,G J, AU - Gadenstaetter,M, AU - Klingler,P J, AU - Weiss,H, AU - Obrist,P, AU - Wykypiel,H, AU - Klaus,A, AU - Profanter,C, PY - 2001/10/31/pubmed PY - 2002/1/5/medline PY - 2001/10/31/entrez SP - 627 EP - 32 JF - Annals of surgery JO - Ann. Surg. VL - 234 IS - 5 N2 - OBJECTIVE: To investigate whether Barrett's metaplasia may develop despite effective medical therapy. SUMMARY BACKGROUND DATA: Gastroesophageal reflux disease has a multifactorial etiology. Therefore, medical treatment may not prevent complications of reflux disease. METHODS: Eighty-three patients with reflux disease and mild esophagitis were prospectively studied for the development of Barrett's metaplasia while receiving long-term therapy with proton pump inhibitors and cisapride. Only patients who had effective control of reflux symptoms and esophagitis were included. The surveillance time was 2 years. The outcome of these 83 patients was compared with that of 42 patients in whom antireflux surgery was performed with a median follow-up of 3.5 years. RESULTS: Twelve (14.5%) patients developed Barrett's while receiving medical therapy; this was not seen after surgery. Patients developing Barrett's had a weaker lower esophageal sphincter and peristalsis before treatment than patients with uncomplicated disease. CONCLUSIONS: Antireflux surgery is superior to medical therapy in the prevention of Barrett's metaplasia. Therefore, patients with reflux disease who have a weak lower esophageal sphincter and poor esophageal peristalsis should undergo antireflux surgery, even if they have only mild esophagitis. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/11685025/Efficacy_of_medical_therapy_and_antireflux_surgery_to_prevent_Barrett's_metaplasia_in_patients_with_gastroesophageal_reflux_disease_ L2 - http://Insights.ovid.com/pubmed?pmid=11685025 DB - PRIME DP - Unbound Medicine ER -