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Antireflux Surgery and Barrett’s Esophagus: Myth or Reality?

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Abstract

Background

It may seem questionable if antireflux surgery still has a role in the management of patients with Barrett’s esophagus (BE) in the current era when antireflux surgery is facing a steady decline, obesity is increasing, pharmacologic treatment for gastroesophageal reflux disease (GERD) is in its splendor, and endoscopic techniques are used more frequently. It is questionable if patients with BE should be operated to stop GERD and to prevent cancer. The aim of this study was to determine the role of antireflux surgery in patients with BE.

Methods

Literature review.

Results

The role of antireflux operations is, in fact, very controversial and neglected. BE is a different phenotype of GERD with a distinct pathophysiology linked to severe reflux of bile and acid, due to a marked anatomic disruption of the gastroesophageal barrier. Published series show that a fundoplication adequately controls GERD and symptoms in BE patients. A fundoplication (or even better a bile diversion antireflux procedure) may prevent esophageal adenocarcinoma.

Conclusions

In conclusion, a fundoplication efficiently controls GERD and symptoms in BE patients. A fundoplication (or even better a bile diversion procedure) may also prevent esophageal adenocarcinoma.

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Author information

Authors and Affiliations

  1. Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP, 04037-003, Brazil

    Fernando A. M. Herbella

  2. Departments of Medicine and Surgery, University of North Carolina, Chapel Hill, NC, USA

    Francisco Schlottmann & Marco G. Patti

Authors
  1. Fernando A. M. Herbella
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  2. Francisco Schlottmann
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  3. Marco G. Patti
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Corresponding author

Correspondence to Fernando A. M. Herbella.

Additional information

Lecture at the 47th World Congress of Surgery, Basel, August, 2017.

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Herbella, F.A.M., Schlottmann, F. & Patti, M.G. Antireflux Surgery and Barrett’s Esophagus: Myth or Reality?. World J Surg 42, 1798–1802 (2018). https://doi.org/10.1007/s00268-017-4394-8

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  • DOI: https://doi.org/10.1007/s00268-017-4394-8

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