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Comparative Study
. 2001 Nov;234(5):627-32.
doi: 10.1097/00000658-200111000-00007.

Efficacy of medical therapy and antireflux surgery to prevent Barrett's metaplasia in patients with gastroesophageal reflux disease

G J Wetscher  1 , M Gadenstaetter, P J Klingler, H Weiss, P Obrist, H Wykypiel, A Klaus, C Profanter
Affiliations
Comparative Study

Efficacy of medical therapy and antireflux surgery to prevent Barrett's metaplasia in patients with gastroesophageal reflux disease

G J Wetscher et al. Ann Surg. 2001 Nov.

Abstract

Objective: To investigate whether Barrett's metaplasia may develop despite effective medical therapy.

Summary background data: Gastroesophageal reflux disease has a multifactorial etiology. Therefore, medical treatment may not prevent complications of reflux disease.

Methods: Eighty-three patients with reflux disease and mild esophagitis were prospectively studied for the development of Barrett's metaplasia while receiving long-term therapy with proton pump inhibitors and cisapride. Only patients who had effective control of reflux symptoms and esophagitis were included. The surveillance time was 2 years. The outcome of these 83 patients was compared with that of 42 patients in whom antireflux surgery was performed with a median follow-up of 3.5 years.

Results: Twelve (14.5%) patients developed Barrett's while receiving medical therapy; this was not seen after surgery. Patients developing Barrett's had a weaker lower esophageal sphincter and peristalsis before treatment than patients with uncomplicated disease.

Conclusions: Antireflux surgery is superior to medical therapy in the prevention of Barrett's metaplasia. Therefore, patients with reflux disease who have a weak lower esophageal sphincter and poor esophageal peristalsis should undergo antireflux surgery, even if they have only mild esophagitis.

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Figures

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Figure 1. Cumulative development of Barrett’s esophagus despite medical therapy.
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Comment in

References

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