title: Efficacy of medical therapy and antireflux surgery to prevent Barrett's metaplasia in patients with gastroesophageal reflux disease.
abstract: OBJECTIVE
  To investigate whether Barrett's metaplasia may develop despite effective medical therapy.
  
  
  BACKGROUND
  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.
authors.affiliation: Department of Surgery, University of Innsbruck, Innsbruck, Austria. gerold.wetscher@uklibk.ac.at
authors.forename: G J
authors.initials: GJ
authors.lastname: Wetscher
authors.forename: M
authors.initials: M
authors.lastname: Gadenstaetter
authors.forename: P J
authors.initials: PJ
authors.lastname: Klingler
authors.forename: H
authors.initials: H
authors.lastname: Weiss
authors.forename: P
authors.initials: P
authors.lastname: Obrist
authors.forename: H
authors.initials: H
authors.lastname: Wykypiel
authors.forename: A
authors.initials: A
authors.lastname: Klaus
authors.forename: C
authors.initials: C
authors.lastname: Profanter
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000209:etiology / Q000517:prevention & control*; D001562:Benzimidazoles / Q000627:therapeutic use; D004942:Esophagitis, Peptic / Q000150:complications / Q000628:therapy; D004943:Esophagogastric Junction / Q000503:physiopathology; D004947:Esophagus / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008365:Manometry; D008679:Metaplasia; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D009853:Omeprazole / Q000627:therapeutic use; D000077402:Pantoprazole; D011446:Prospective Studies; D013454:Sulfoxides / Q000627:therapeutic use
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D013454:Sulfoxides; D000077402:Pantoprazole; D009853:Omeprazole