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Bile reflux in benign and malignant Barrett's esophagus: effect of medical acid suppression and nissen fundoplication.
J Gastrointest Surg 1998 Jul-Aug; 2(4):333-41JG

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.

Authors+Show Affiliations

Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, München, Germany.No affiliation info availableNo affiliation info availableNo affiliation info available

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 -