Skip to main content

Advertisement

SpringerLink
Log in

The patterns of reflux can affect regression of non-dysplastic and low-grade dysplastic Barrett’s esophagus after medical and surgical treatment: a prospective case–control study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

To date, therapeutic guidelines and pattern of reflux for patients with no-dysplasia (ND) or low-grade dysplasia (LGD) Barrett’s esophagus (BE) remain unclear. We aimed to analyze pattern of reflux and regression of ND- or LGD-BE after medical and surgical treatment.

Methods

We studied a cohort of ND- and LGD-BE patients who underwent laparoscopic total fundoplication and a cohort of ND- and LGD-BE patients managed medically. Patients were matched for age, sex, and disease duration. After 1 year of follow-up at least, all patients underwent upper endoscopy with esophageal biopsies to evaluate any histological changes, as well as manometry and impedance-pH-metry to re-assess reflux patterns.

Results

Thirty-seven patients (20 LGD, 17 ND) undergoing laparoscopic fundoplication were enrolled and compared with 25 patients (13 LGD, 12 ND) managed with proton pump inhibitors (PPI). Laparoscopic fundoplication resulted in a better control of both acidic and weakly acidic reflux (P < 0.001) and was associated with a higher probability of reversion for LGD (P < 0.01). Esophageal motility did not differ between surgically and medically treated patients.

Conclusions

In patients with ND- or LGD-BE, laparoscopic fundoplication seems to warrant a better control of all kinds of refluxate and it is associated with a higher likelihood of reversion of both LGD- and ND-BE, compared with PPI therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Falk JW (2002) Barrett’s esophagus. Gastroenterology 122:1569–1591

    Article  PubMed  Google Scholar 

  2. Cameron AJ, Ott BJ, Payne WS (1985) The incidence of adenocarcinoma in columnar-lined (Barrett’s) esophagus. N Engl J Med 313:857–859

    Article  CAS  PubMed  Google Scholar 

  3. Fitzgerald RC, Saeed IT, Khoo D, Farthing MJ, Burnham WR (2001) Rigorous surveillance protocol increases detection of curable cancers associated with Barrett’s esophagus. Dig Dis Sci 46:1892–1898

    Article  CAS  PubMed  Google Scholar 

  4. Wani S, Falk G, Hall M, Gaddam S, Wang A, Gupta N, Singh M, Singh V, Chuang KY, Boolchand V, Gavini H, Kuczynski J, Sud P, Reddymasu S, Bansal A, Rastogi A, Mathur SC, Young P, Cash B, Lieberman DA, Sampliner RE, Sharma P (2011) Patients with nondysplastic Barrett’s esophagus have low risks for developing dysplasia or esophageal adenocarcinoma. Clin Gastroenterol Hepatol 9:220–227; quiz e26

  5. Spechler SJ (2002) Barrett’s esophagus and esophageal adenocarcinoma: pathogenesis, diagnosis, and therapy. Med Clin North Am 86:1423–1445

    Article  PubMed  Google Scholar 

  6. Eloubeidi MA, Desmond R, Arguedas MR, Reed CE, Wilcox CM (2002) Prognostic factors for the survival of patients with esophageal carcinoma in the US: the importance of tumor length and lymph node status. Cancer 95:1434–1443

    Article  PubMed  Google Scholar 

  7. Richter JE (2003) What is the long-term significance of low-grade dysplasia? In: Giuli R (ed) Barrett’s esophagus, vol 1. John Libbey Eurotext, Paris, p 306

    Google Scholar 

  8. Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ (2011) American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology 140:e18–e52

    Article  PubMed Central  PubMed  Google Scholar 

  9. Winters C Jr, Spurling TJ, Chobanian SJ, Curtis DJ, Esposito RL, Hacker JF 3rd, Johnson DA, Cruess DF, Cotelingam JD, Gurney MS (1987) Barrett’s esophagus: a prevalent, occult complication of gastroesophageal reflux disease. Gastroenterology 92:118–124

    PubMed  Google Scholar 

  10. Csendes A, Smok G, Burdiles P, Korn O, Gradiz M, Rojas J, Recio M (2003) Prevalence of intestinal metaplasia according to the length of the specialized columnar epithelium lining the distal esophagus in patients with gastroesophageal reflux. Dis Esophagus 16:24–28

    Article  CAS  PubMed  Google Scholar 

  11. Huo X, Zhang HY, Zhang XI, Lynch JP, Strauch ED, Wang JY, Melton SD, Genta RM, Wang DH, Spechler SJ, Souza RF (2010) Acid and bile salt induced CDX2 expression differs in squamous cells from patients with and without Barrett’s esophagus. Gastroenterology 139(194–203):e1

    PubMed  Google Scholar 

  12. Souza RF, Krishnan K, Spechler SJ (2008) Acid, bile, and CDX: the ABCs of making Barrett’s metaplasia. Am J Physiol Gastrointest Liver Physiol 295:G211–G218

    Article  CAS  PubMed  Google Scholar 

  13. Triadafilopoulos G (2001) Acid and bile reflux in Barrett’s esophagus: a tale of two evils. Gastroenterology 121:1502–1506

    Article  CAS  PubMed  Google Scholar 

  14. Hong J, Behar J, Wands J, Resnick M, Wang LJ, DeLellis RA, Lambeth D, Souza RF, Spechler SJ, Cao W (2010) Role of a novel bile acid receptor TGR5 in the development of oesophageal adenocarcinoma. Gut 59:170–180

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Dvorak K, Payne CM, Chavarria M, Ramsey L, Dvorakova B, Bernstein H, Holubec H, Sampliner RE, Guy N, Condon A, Bernstein C, Green SB, Prasad A, Garewal HS (2007) Bile acids in combination with low pH induce oxidative stress and oxidative DNA damage: relevance to the pathogenesis of Barrett’s oesophagus. Gut 56:763–771

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Savarino E, Zentilin P, Frazzoni M, Cuoco DL, Pohl D, Dulbecco P, Marabotto E, Sammito G, Gemignani L, Tutuian R, Savarino V (2010) Characteristics of gastro-esophageal reflux episodes in Barrett’s esophagus, erosive esophagitis and healthy volunteers. Neurogastroenterol Motil 22:1061-e280

    Article  PubMed  Google Scholar 

  17. Krishnan K, Pandolfino JE, Kahrilas PJ, Keefer L, Boris L, Komanduri S (2012) Increased risk for persistent intestinal metaplasia in patients with Barrett’s esophagus and uncontrolled reflux exposure before radiofrequency ablation. Gastroenterology 143:576–581

    Article  PubMed Central  PubMed  Google Scholar 

  18. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, Johnson F, Hongo M, Richter JE, Spechler SJ, Tytgat GN, Wallin L (1999) Endoscopic assessment of esophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 45:172–180

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Wang KK, Samplimer RE (2008) Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol 103:788–797

    Article  PubMed  Google Scholar 

  20. Riddell RH, Goldman H, Ransohoff DF, Appelman HD, Fenoglio CM, Haggitt RC, Ahren C, Correa P, Hamilton SR, Morson BC (1983) Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical application. Hum Pathol 14:931–938

    Article  CAS  PubMed  Google Scholar 

  21. Roman S, Lin Z, Kwiatek MA, Pandolfino JE, Kahrilas PJ (2011) Weak peristalsis in esophageal pressure topography: classification and association with dysphagia. Am J Gastr 106:349–356

    Article  Google Scholar 

  22. Tutuian R, Vela MF, Shay SS, Castell DO (2003) Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring. J Clin Gastroenterol 37:206–215

    Article  PubMed  Google Scholar 

  23. Sifrim D, Castell D, Dent J, Kahrilas PJ (2004) Gastro-esophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut 53:1024–1031

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Del Genio G, Rossetti G, Brusciano L, Limongelli P, Pizza F, Tolone S, Fei L, Maffettone V, Napolitano V, del Genio A (2007) Laparoscopic Nissen-Rossetti fundoplication with routine use of intraoperative endoscopy and manometry: technical aspects of a standardized technique. World J Surg 31:1099–1106

    PubMed  Google Scholar 

  25. Amato G, Limongelli P, Pascariello A, Rossetti G, Del Genio G, Del Genio A, Iovino P (2008) Association between persistent symptoms and long-term quality of life after laparoscopic total fundoplication. Am J Surg 196:582–586

    Article  PubMed  Google Scholar 

  26. Rugge M, Correa P, Dixon MF, Hattori T, Leandro G, Lewin K, Riddell RH, Sipponen P, Watanabe H (2000) Gastric dysplasia: the Padova International classification. Am J Surg Path 24:167–176

    Article  CAS  PubMed  Google Scholar 

  27. Cooper BT, Neumann CS, Cox MA, Iqbal TH (1998) Continuous treatment with omeprazole 20 mg daily for up to 6 years in Barrett’s oesophagus. Aliment Pharmacol Ther 12:893–897

    Article  CAS  PubMed  Google Scholar 

  28. Sharma P, Morales TG, Bhattacharyya A, Garewal HS, Sampliner RE (1998) Squamous islands in Barrett’s esophagus: what lies underneath? Am J Gastroenterol 93:332–335

    Article  CAS  PubMed  Google Scholar 

  29. Spechler SJ, Sharma P, Traxler B, Levine D, Falk GW (2006) Gastric and esophageal pH in patients with Barrett’s esophagus treated with three esomeprazole dosages: a randomized, double-blind, crossover trial. Am J Gastroenterol 101:1964–1971

    Article  CAS  PubMed  Google Scholar 

  30. Katzka DA, Castell DO (1994) Successful elimination of reflux symptoms does not insure adequate control of acid reflux in patients with Barrett’s esophagus. Am J Gastroenterol 89:989–991

    CAS  PubMed  Google Scholar 

  31. Stein HJ, Barlow AP, DeMeester TR, Hinder RA (1992) Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux. Ann Surg 216:35–43

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Csendes A, Burdiles P, Braghetto I, Smok G, Castro C, Korn O, Henríquez A (2002) Dysplasia and adenocarcinoma after classic antireflux surgery in patients with Barrett’s esophagus: the need for long-term subjective and objective follow-up. Ann Surg 235:178–185

    Article  PubMed Central  PubMed  Google Scholar 

  33. Del Genio G, Tolone S, del Genio F, Rossetti G, Brusciano L, Pizza F, Fei L, del Genio A (2008) Total fundoplication controls acid and non acid reflux: evaluation by pre- and postoperative 24-hour pH-multichannel intraluminal impedance. Surg Endosc 22:2518–2523

    Article  PubMed  Google Scholar 

  34. Mainie I, Tutuian R, Agrawal A, Adams D, Castell DO (2006) Combined multichannel intraluminal impedance-pH monitoring to select patients with persistent gastro-oesophageal reflux for laparoscopic Nissen fundoplication. Br J Surg 93:1483–1487

    Article  CAS  PubMed  Google Scholar 

  35. del Genio G, Tolone S, del Genio F, D’Alessandro A, Brusciano L, Aggarwal R, Conzo G, Orditura M, Docimo L, Del Genio A (2012) Impact of total fundoplication on esophageal transit: analysis by combined multichannel intraluminal impedance and manometry. J Clin Gastroenterol 46:e1–e5

    Article  PubMed  Google Scholar 

  36. Oelschager BK, Barreca M, Chang L, Oleynikov D, Pellegrini CA (2003) Clinical and pathologic response of Barrett’s esophagus after antireflux surgery. Ann Surg 238:458–466

    Google Scholar 

  37. Gurski RR, Peters JH, Hagen JA, DeMeester SR, Bremner CG, Chandrasoma PT, DeMeester TR (2003) Barrett’s esophagus can and does regress after antireflux surgery: a study of prevalence and predictive factors. J Am Coll Surg 196:706–713

    Article  PubMed  Google Scholar 

  38. Zaninotto G, Cassaro M, Pennelli G, Battaglia G, Farinati F, Ceolin M, Costantini M, Ruol A, Guirroli E, Rizzetto C, Portale G, Ancona E, Rugge M (2005) Barrett’s epithelium after antireflux surgery. J Gastrointest Surg 9:1253–1261

    Article  PubMed  Google Scholar 

  39. Csendes A, Braghetto I, Burdiles P, Smok G, Henríquez A, Burgos AM (2009) Late results of the surgical treatment of 125 patients with short-segment Barrett Esophagus. Arch Surg 144:921–927

    Article  PubMed  Google Scholar 

  40. Sharma P, Falk GW, Weston AP, Reker D, Johnston M, Sampliner RE (2002) Natural history of low-grade dysplasia: an infrequent finding which usually regresses. Preliminary results from the Barrett’s esophagus study. Gastroenterology 122:A20

    Article  Google Scholar 

  41. Parrilla P, Martinez de Haro LF, Ortiz A, Munitiz V, Molina J, Bermejo J, Canteras M (2003) Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett’s esophagus. Ann Surg 237:291–298

    PubMed Central  PubMed  Google Scholar 

  42. Conio M, Blanchi S, Lapertosa G, Ferraris R, Sablich R, Marchi S, D’Onofrio V, Lacchin T, Iaquinto G, Missale G, Ravelli P, Cestari R, Benedetti G, Macrì G, Fiocca R, Munizzi F, Filiberti R (2003) Long-term endoscopic surveillance of patients with Barrett’s esophagus: incidence of dysplasia and adenocarcinoma. A prospective study. Am J Gastroenterol 98:1931–1939

    Article  PubMed  Google Scholar 

Download references

Disclosures

Salvatore Tolone, Paolo Limongelli, Marco Romano, Alessandro Federico, Giovanni Docimo, Roberto Ruggiero, Luigi Brusciano, Gianmattia Del Genio, and Ludovico Docimo have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Division of General and Bariatric Surgery, Department of Surgery, Second University of Naples, Via Pansini, 5, 80131, Naples, NA, Italy

    Salvatore Tolone, Paolo Limongelli, Giovanni Docimo, Roberto Ruggiero, Luigi Brusciano, Gianmattia Del Genio & Ludovico Docimo

  2. Division of Gastroenterology, Second University of Naples, Naples, Italy

    Marco Romano & Alessandro Federico

Authors
  1. Salvatore Tolone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paolo Limongelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alessandro Federico
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giovanni Docimo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roberto Ruggiero
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luigi Brusciano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gianmattia Del Genio
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ludovico Docimo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Salvatore Tolone.

Additional information

Tolone and Limongelli shared co-first authorship.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tolone, S., Limongelli, P., Romano, M. et al. The patterns of reflux can affect regression of non-dysplastic and low-grade dysplastic Barrett’s esophagus after medical and surgical treatment: a prospective case–control study. Surg Endosc 29, 648–657 (2015). https://doi.org/10.1007/s00464-014-3713-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3713-5

Keywords

Search

Navigation