Efficacy of Nissen fundoplication versus medical therapy in the regression of low-grade dysplasia in patients with Barrett esophagus: a prospective study.
OBJECTIVE
The aim of this study is to compare the effect of medical and surgical treatment on the history of patients with Barrett esophagus (BE) and histologic evidence of low-grade dysplasia (LGD).


BACKGROUND
BE is a complication of severe gastroesophageal reflux. It is considered a major risk factor for esophageal adenocarcinoma, which may develop through stages from nondysplastic metaplasia to dysplasia (LGD and high-grade dysplasia). Presently, there are no recommended therapeutic guidelines for patients with LGD.


METHODS
Between 1998 through 2003, 6592 patients underwent upper endoscopy; 327 of 6592 (5%) patients had BE, and 35 of 327 (10.7%) had LGD. Nineteen patients with LGD were treated with high-dose proton pump inhibitors, and 16 patients underwent laparoscopic Nissen fundoplication. Endoscopic and histologic follow-up was available in all patients after 18 months. We used multiple logistic regression to examine the effect of the 2 treatments on regression of LGD.


RESULTS
LGD was predominant in men (male-to-female ratio: 1.7:1). Mean age was 58 +/- 13.5 years. Sixty percent of patients had no endoscopic evidence of esophagitis. A regression from LGD to BE was observed in 12 of 19 (63.2%) patients in the medical group and in 15 of 16 (93.8%) patients in the surgical group (statistically significant difference). Differences between the 2 groups were statistically significant (P = 0.03).


CONCLUSIONS
The results of our study suggest that surgical treatment may be more effective than medical therapy to modify the natural history of LGD in patients with BE, perhaps because it not only controls acid but also biliopancreatic reflux into the esophagus.
Rossi
Mauro
M
General Surgery IV, Regional Referral Center for Esophageal Pathology, Department of Medical and Surgical Gastroenterology, AOU Pisana, Pisa, Italy.
Barreca
Marco
M
de Bortoli
Nicola
N
Renzi
Cristina
C
Santi
Stefano
S
Gennai
Alessandro
A
Bellini
Massimo
M
Costa
Francesco
F
Conio
Massimo
M
Marchi
Santino
S
D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology* / Q000628:therapy*; D018450:Disease Progression; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D004947:Esophagus / Q000473:pathology; D005260:Female; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D012074:Remission Induction; D016896:Treatment Outcome
D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D009853:Omeprazole