Barrett's oesophagus: effect of antireflux surgery on symptom control and development of complications.
Forty-five patients with histologically proven Barrett's columnar-lined oesophagus (CLO) were treated in one unit over a 9-year period. Patients were studied prospectively as part of a surveillance programme; all initially received standard conservative treatment including high-dose H2-receptor antagonists. A satisfactory initial response was seen in 21 patients, but in 24 the symptoms were unchanged or progressed; 19 patients in the latter group were considered suitable for antireflux surgery and underwent fundoplication. Symptoms of heartburn or dysphagia persisted or recurred in 88 per cent of patients receiving medical treatment alone and complications developed in 38 per cent, including nine strictures and one adenocarcinoma. In patients undergoing antireflux surgery, symptoms persisted or recurred in 21 per cent and complications developed in 16 per cent (P < 0.01). Complete regression of Barrett's CLO occurred in two patients (11 per cent) after antireflux surgery. The results of this study suggest the superiority of antireflux surgery over pharmacological acid suppression in the control of symptoms and prevention of complications in patients with Barrett's CLO.
Attwood
S E
SE
Department of Surgery, Royal Lancaster Infirmary, UK.
Barlow
A P
AP
Norris
T L
TL
Watson
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000464:Alginates / Q000627:therapeutic use; D000536:Aluminum Hydroxide / Q000627:therapeutic use; D000863:Antacids / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000188:drug therapy / Q000601:surgery*; D001639:Bicarbonates / Q000627:therapeutic use; D004338:Drug Combinations; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005748:Gastric Fundus / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011899:Ranitidine / Q000627:therapeutic use; D012824:Silicic Acid / Q000627:therapeutic use; D017693:Sodium Bicarbonate; D016896:Treatment Outcome
D000464:Alginates; D000863:Antacids; D001639:Bicarbonates; D004338:Drug Combinations; D012824:Silicic Acid; D000536:Aluminum Hydroxide; C007829:alginate, aluminium hydroxide, magnesium trisilicate, sodium bicarbonate drug combination; D011899:Ranitidine; D017693:Sodium Bicarbonate