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Bile reflux in benign and malignant Barrett's esophagus: effect of medical acid suppression and nissen fundoplication.

Abstract

Bile reflux has been implicated in the pathogenesis and malignant degeneration of Barrett's esophagus, but clinical studies in patients with adenocarcinoma arising in Barrett's esophagus are lacking. Ambulatory esophageal measurement of acid and bile reflux was performed with the previously validated fiberoptic bilirubin monitoring system (Bilitec) combined with a pH probe in 20 asymptomatic volunteers, 19 patients with gastroesophageal reflux disease (GERD) but no mucosal injury, 45 patients with GERD and erosive esophagitis, 33 patients with GERD and Barrett's esophagus, and 14 patients with early adenocarcinoma arising in Barrett's esophagus. Repeat studies were done in 15 patients under medical acid suppression and 16 patients after laparoscopic Nissen fundoplication. The mean esophageal bile exposure time showed an exponential increase from GERD patients without esophagitis to those with erosive esophagitis and benign Barrett's esophagus and was highest in patients with early carcinoma in Barrett's esophagus (P <0.01). Pathologic esophageal bile exposure was documented in 18 (54.5%) of 33 patients with benign Barrett's esophagus and 11 (78.6%) of 14 patients with early adenocarcinoma in Barrett's esophagus. Nissen fundoplication but not medical acid suppression resulted in complete suppression of bile reflux. Bile reflux into the esophagus is particularly prevalent in patients with Barrett's esophagus and early cancer. Bile reflux into the esophagus can be completely suppressed by Nissen fundoplication but not medical acid suppression alone.

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  • Authors+Show Affiliations

    ,

    Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, München, Germany.

    , ,

    Source

    MeSH

    Adenocarcinoma
    Adult
    Anti-Ulcer Agents
    Barrett Esophagus
    Bile
    Bile Reflux
    Bilirubin
    Enzyme Inhibitors
    Esophageal Neoplasms
    Esophagitis, Peptic
    Esophagus
    Female
    Fiber Optic Technology
    Fundoplication
    Gastric Acid
    Gastroesophageal Reflux
    Humans
    Hydrogen-Ion Concentration
    Laparoscopy
    Male
    Middle Aged
    Monitoring, Ambulatory
    Omeprazole
    Proton Pump Inhibitors

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    9841990

    Citation

    Stein, H J., et al. "Bile Reflux in Benign and Malignant Barrett's Esophagus: Effect of Medical Acid Suppression and Nissen Fundoplication." Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, vol. 2, no. 4, 1998, pp. 333-41.
    Stein HJ, Kauer WK, Feussner H, et al. Bile reflux in benign and malignant Barrett's esophagus: effect of medical acid suppression and nissen fundoplication. J Gastrointest Surg. 1998;2(4):333-41.
    Stein, H. J., Kauer, W. K., Feussner, H., & Siewert, J. R. (1998). Bile reflux in benign and malignant Barrett's esophagus: effect of medical acid suppression and nissen fundoplication. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 2(4), pp. 333-41.
    Stein HJ, et al. Bile Reflux in Benign and Malignant Barrett's Esophagus: Effect of Medical Acid Suppression and Nissen Fundoplication. J Gastrointest Surg. 1998;2(4):333-41. PubMed PMID: 9841990.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Bile reflux in benign and malignant Barrett's esophagus: effect of medical acid suppression and nissen fundoplication. AU - Stein,H J, AU - Kauer,W K, AU - Feussner,H, AU - Siewert,J R, PY - 1998/12/8/pubmed PY - 1998/12/8/medline PY - 1998/12/8/entrez SP - 333 EP - 41 JF - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JO - J. Gastrointest. Surg. VL - 2 IS - 4 N2 - Bile reflux has been implicated in the pathogenesis and malignant degeneration of Barrett's esophagus, but clinical studies in patients with adenocarcinoma arising in Barrett's esophagus are lacking. Ambulatory esophageal measurement of acid and bile reflux was performed with the previously validated fiberoptic bilirubin monitoring system (Bilitec) combined with a pH probe in 20 asymptomatic volunteers, 19 patients with gastroesophageal reflux disease (GERD) but no mucosal injury, 45 patients with GERD and erosive esophagitis, 33 patients with GERD and Barrett's esophagus, and 14 patients with early adenocarcinoma arising in Barrett's esophagus. Repeat studies were done in 15 patients under medical acid suppression and 16 patients after laparoscopic Nissen fundoplication. The mean esophageal bile exposure time showed an exponential increase from GERD patients without esophagitis to those with erosive esophagitis and benign Barrett's esophagus and was highest in patients with early carcinoma in Barrett's esophagus (P <0.01). Pathologic esophageal bile exposure was documented in 18 (54.5%) of 33 patients with benign Barrett's esophagus and 11 (78.6%) of 14 patients with early adenocarcinoma in Barrett's esophagus. Nissen fundoplication but not medical acid suppression resulted in complete suppression of bile reflux. Bile reflux into the esophagus is particularly prevalent in patients with Barrett's esophagus and early cancer. Bile reflux into the esophagus can be completely suppressed by Nissen fundoplication but not medical acid suppression alone. SN - 1091-255X UR - https://www.unboundmedicine.com/medline/citation/9841990/Bile_reflux_in_benign_and_malignant_Barrett's_esophagus:_effect_of_medical_acid_suppression_and_nissen_fundoplication_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1091-255X(98)80072-3 DB - PRIME DP - Unbound Medicine ER -