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[Comparison of surgical patients with gastroesophageal reflux disease and Barrett's esophagus].

Abstract

INTRODUCTION

Barrett's esophagus (BE) is the only known precursor of adenocarcinoma occuring in the lower third of the esophagus. According to statistics, severity and elapsed time of gastroesophageal reflux disease (GERD) are major pathogenetic factors in the development of Barrett's esophagus.

PATIENTS AND METHODS

In a retrospective study between 2001 and 2008, we compared the preoperative results (signs and sympthoms, 24 hour pH manometry, esophageal manometry, Bilitec) and treatment efficacy of 176 GERD patients and 78 BE patients, who have undergone laparoscopic Nissen procedure for reflux disease.

RESULTS

The two groups of patients had similar demographic features, and elapsed time of reflux sympthoms were also equal. Both groups were admitted for surgery after a median time of 1.5 years (19.87 vs. 19.20 months) of ineffective medical (proton pump inhibitors) treatment. Preoperative functional tests showed a more severe presence of acid reflux in the BE group (DeMeester score 18.9 versus 41.9, p < 0.001). On the other hand, mano-metry - despite confirming lower esophageal sphincter (LES) damage - did not show difference between the two groups (12.10 vs. 12.57 mmHg, p = 0.892). We did not experience any mortality cases with laparoscopic antireflux procedures, although in two cases we had to convert during the operation (1 due to extensive adhesions, and 1 due to injury to the spleen). 3 months after the procedure - according to Visick score - both groups experienced a significant decrease, or lapse in reflux complaints (group I: 73%, group II: 81% of patients), LES functions improved (17.58 vs.18.70 mmHg), and the frequency and exposition of acid reflux decreased (DeMeester score 7.73 vs. 12.72).

CONCLUSION

The severity of abnormal acid reflux occuring parallel with the incompetent function of the damaged LES triggers not only inflammation in the gastroesophageal junction (GEJ), but also metaplastic process, and the development of Barrett's esophagus. Laparoscopic Nissen procedure for reflux disease can further improve outcome among patients with GERD not responding to conservative therapy.

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  • Authors+Show Affiliations

    ,

    Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.

    ,

    Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.

    ,

    Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.

    ,

    Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.

    ,

    Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.

    ,

    Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.

    ,

    Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.

    ,

    Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.

    ,

    Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.

    ,

    Szegedi Tudományegyetem Patológiai Intézet Szeged.

    ,

    Szegedi Tudományegyetem Patológiai Intézet Szeged.

    ,

    Szegedi Tudományegyetem I. Sz. Belgyógyászati Klinika Szeged.

    ,

    Szegedi Tudományegyetem I. Sz. Belgyógyászati Klinika Szeged.

    ,

    Szegedi Tudományegyetem I. Sz. Belgyógyászati Klinika Szeged.

    Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.

    Source

    Magyar sebeszet 67:5 2014 Oct pg 287-96

    MeSH

    Adenocarcinoma
    Adult
    Aged
    Barrett Esophagus
    Esophageal Neoplasms
    Female
    Fundoplication
    Gastroesophageal Reflux
    Humans
    Laparoscopy
    Male
    Manometry
    Middle Aged
    Postprandial Period
    Proton Pump Inhibitors
    Retrospective Studies
    Severity of Illness Index
    Time Factors

    Pub Type(s)

    Comparative Study
    English Abstract
    Journal Article

    Language

    hun

    PubMed ID

    25327403

    Citation

    Zsolt, Simonka, et al. "[Comparison of Surgical Patients With Gastroesophageal Reflux Disease and Barrett's Esophagus]." Magyar Sebeszet, vol. 67, no. 5, 2014, pp. 287-96.
    Zsolt S, Paszt A, Géczi T, et al. [Comparison of surgical patients with gastroesophageal reflux disease and Barrett's esophagus]. Magy Seb. 2014;67(5):287-96.
    Zsolt, S., Paszt, A., Géczi, T., Abrahám, S., Tóth, I., Horváth, Z., ... Lázár, G. (2014). [Comparison of surgical patients with gastroesophageal reflux disease and Barrett's esophagus]. Magyar Sebeszet, 67(5), pp. 287-96. doi:10.1556/MaSeb.67.2014.5.1.
    Zsolt S, et al. [Comparison of Surgical Patients With Gastroesophageal Reflux Disease and Barrett's Esophagus]. Magy Seb. 2014;67(5):287-96. PubMed PMID: 25327403.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - [Comparison of surgical patients with gastroesophageal reflux disease and Barrett's esophagus]. AU - Zsolt,Simonka, AU - Paszt,Attila, AU - Géczi,Tibor, AU - Abrahám,Szabolcs, AU - Tóth,Illés, AU - Horváth,Zoltán, AU - Pieler,József, AU - Tajti,János, AU - Varga,Akos, AU - Tiszlavicz,László, AU - Németh,István, AU - Izbéki,Ferenc, AU - Rosztóczy,András, AU - Wittmann,Tibor, AU - Lázár,György, PY - 2014/10/21/entrez PY - 2014/10/21/pubmed PY - 2015/3/17/medline KW - Barrett-nyelőcső KW - Barrett’s esophagus KW - antireflux műtét KW - antireflux procedure KW - laparoscopic Nissen fundoplication KW - laparoscopos Nissen-fundoplicatio KW - reflux disease KW - refluxbetegség (gastrooesophagealis refluxbetegség) SP - 287 EP - 96 JF - Magyar sebeszet JO - Magy Seb VL - 67 IS - 5 N2 - INTRODUCTION: Barrett's esophagus (BE) is the only known precursor of adenocarcinoma occuring in the lower third of the esophagus. According to statistics, severity and elapsed time of gastroesophageal reflux disease (GERD) are major pathogenetic factors in the development of Barrett's esophagus. PATIENTS AND METHODS: In a retrospective study between 2001 and 2008, we compared the preoperative results (signs and sympthoms, 24 hour pH manometry, esophageal manometry, Bilitec) and treatment efficacy of 176 GERD patients and 78 BE patients, who have undergone laparoscopic Nissen procedure for reflux disease. RESULTS: The two groups of patients had similar demographic features, and elapsed time of reflux sympthoms were also equal. Both groups were admitted for surgery after a median time of 1.5 years (19.87 vs. 19.20 months) of ineffective medical (proton pump inhibitors) treatment. Preoperative functional tests showed a more severe presence of acid reflux in the BE group (DeMeester score 18.9 versus 41.9, p < 0.001). On the other hand, mano-metry - despite confirming lower esophageal sphincter (LES) damage - did not show difference between the two groups (12.10 vs. 12.57 mmHg, p = 0.892). We did not experience any mortality cases with laparoscopic antireflux procedures, although in two cases we had to convert during the operation (1 due to extensive adhesions, and 1 due to injury to the spleen). 3 months after the procedure - according to Visick score - both groups experienced a significant decrease, or lapse in reflux complaints (group I: 73%, group II: 81% of patients), LES functions improved (17.58 vs.18.70 mmHg), and the frequency and exposition of acid reflux decreased (DeMeester score 7.73 vs. 12.72). CONCLUSION: The severity of abnormal acid reflux occuring parallel with the incompetent function of the damaged LES triggers not only inflammation in the gastroesophageal junction (GEJ), but also metaplastic process, and the development of Barrett's esophagus. Laparoscopic Nissen procedure for reflux disease can further improve outcome among patients with GERD not responding to conservative therapy. SN - 0025-0295 UR - https://www.unboundmedicine.com/medline/citation/25327403/[Comparison_of_surgical_patients_with_gastroesophageal_reflux_disease_and_Barrett's_esophagus]_ L2 - http://www.akademiai.com/doi/full/10.1556/MaSeb.67.2014.5.1?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -