title: Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett's esophagus.
abstract: OBJECTIVE
  To compare the results of medical treatment and antireflux surgery in patients with Barrett's esophagus (BE).
  
  
  BACKGROUND
  The treatment of choice in BE is still controversial. Some clinical studies suggest that surgery could be more effective than medical treatment in preventing BE from progressing to dysplasia and adenocarcinoma. However, data from prospective comparative studies are necessary to answer this question.
  
  
  METHODS
  One hundred one patients were included in a randomized prospective study, 43 with medical treatment and 58 with antireflux surgery. All patients underwent clinical, endoscopic, and histologic assessment. Functional studies were performed in all the operated patients and in a subgroup of patients receiving medical treatment. The median follow-up was 5 years (range 1-18) in the medical treatment group and 6 years (range 1-18) in the surgical treatment group.
  
  
  RESULTS
  Satisfactory clinical results (excellent to good) were achieved in 39 of the 43 patients (91%) undergoing medical treatment and in 53 of the 58 patients (91%) following antireflux surgery. The persistence of added inflammatory lesions was significantly higher in the medical treatment group. The metaplastic segment did not disappear in any case. Postoperative functional studies showed a significant decrease in the median percentage of total time with pH below 4, although 9 of the 58 patients (15%) showed pathologic rates of acid reflux. High-grade dysplasia appeared in 2 of the 43 patients (5%) in the medical treatment group and in 2 of the 58 patients (3%) in the surgical treatment group. In the latter, both patients presented with clinical and pH-metric recurrence. There was no case of malignancy after successful antireflux surgery.
  
  
  CONCLUSIONS
  These results show that there are no differences between the two types of treatment with respect to preventing BE from progressing to dysplasia and adenocarcinoma. However, successful antireflux surgery proved to be more efficient than medical treatment in this sense, perhaps because it completely controls acid and biliopancreatic reflux to the esophagus.
authors.affiliation: Department of Surgery, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain. parricir@huva.es
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla
authors.forename: Luisa F
authors.initials: LF
authors.lastname: Martínez de Haro
authors.forename: Angeles
authors.initials: A
authors.lastname: Ortiz
authors.forename: Vicente
authors.initials: V
authors.lastname: Munitiz
authors.forename: Joaquín
authors.initials: J
authors.lastname: Molina
authors.forename: Juan
authors.initials: J
authors.lastname: Bermejo
authors.forename: Manuel
authors.initials: M
authors.lastname: Canteras
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D002648:Child; D004938:Esophageal Neoplasms / Q000209:etiology / Q000517:prevention & control; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005745:Gastric Acidity Determination; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D011183:Postoperative Complications; D011446:Prospective Studies
chemical_list: D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D009853:Omeprazole