[Conservative and surgical antireflux therapy as prevention of carcinoma].
BACKGROUND
Based on findings in literature, the effectiveness of the medical versus operative antireflux therapy was examined as a prophylaxis to impede the formation of an adenocarcinoma in the case of Barrett esophagus.
Despite reports of success following the administration of Omeprazole, the inhibition of acid secretion does not lead to the regression of the endobrachyesophagus for most patients. The partial shortening of the Barrett segment is reported in up to 78% of cases, however the precancerous changes of the distal esophagus are not eliminated. In spite of medical therapy with proton pump inhibitors, up to 6% of dysplasias become metaplasias per year. In 3% of the patients, an adenocarcinoma arises.
It is reported in the literature that there is a partial regression of the endobrachyesophagus in up to 34% of cases and complete regression in up to 11% of cases following operative antireflux therapy. Despite a macroscopically unchanged Barrett segment following a fundoplication or semifundoplication procedure, a complete regression of minor dysplasias and the complete regression of intestinal metaplasias is possible. In only 30% of patients, postoperative atypical findings were ascertainable. Nevertheless, a severe change can appear in the cylinder epithelium of the remaining Barrett segment following an operative antireflux therapy, up to the formation of an adenocarcinoma (1-9%). For this reason, the patients must be endoscopically and histologically examined at regular intervals following the antireflux operation.


CONCLUSIONS
In the case of evidence of severe dysplasias in the Barrett segment, the attempt at carcinoma prophylaxis by means of antireflux therapy is no longer indicated. With the appearance of mild dysplasias and complete intestinal metaplasias in the Barrett esophagus, an antireflux operation can lead to a reduction in the grade of atypical cells. In cases of existing metaplasia or the presence of mild dysplasias, the administration of proton pump inhibitors or H2 blockers is only indicated as a symptomatic therapy.
Klinik und Poliklinik für Abdominal- und Allgemeinchirurgie, Johannes Gutenberg-Universität Mainz. joerg-sauer@kolo-proktologie.de
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J
Sauer
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Junginger
D000230:Adenocarcinoma / Q000517:prevention & control*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000150:complications* / Q000473:pathology; D001706:Biopsy; D002986:Clinical Trials as Topic; D004938:Esophageal Neoplasms / Q000517:prevention & control*; D004947:Esophagus / Q000473:pathology; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008679:Metaplasia; D009853:Omeprazole / Q000627:therapeutic use; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D013997:Time Factors
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D009853:Omeprazole