title: Peptic ulcer in acquired columnar-lined esophagus: results of surgical treatment.
abstract: Ulcerative peptic esophagitis may lead to the progressive replacement of squamous by columnar epithelium in the distal esophagus. A typical peptic ulcer (Barrett's ulcer) may develop in the columnar-lined segment, although this is a rare occurrence. Between 1975 and 1985 at Toronto General Hospital we treated 11 patients with penetrating peptic ulcer and acquired, columnar-lined esophagus. Presenting symptoms related to the ulcer were precordial and lower dorsal back pain in 4 patients, dysphagia in 6, and massive hemorrhage of the upper gastrointestinal tract in 4. None of the ulcers healed following a trial of medical therapy, and ultimately all 11 patients underwent antireflux procedures (gastroplasty and partial fundoplication). There was one operative death. Complete healing of the ulcer was observed in the 8 patients who underwent follow-up endoscopy between two and five months after operation. There has been no recurrence of symptoms resulting from ulcer in subsequent follow-up, which extends from 1 to 11 years (mean, 5 years). Adenocarcinoma developed in the columnar-lined segment in 2 of the 11 patients, which was diagnosed at 32 and 91 months following operation, respectively.
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004935:Esophageal Diseases / Q000601:surgery*; D004942:Esophagitis, Peptic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery