title: Efficacy of Nissen fundoplication versus medical therapy in the regression of low-grade dysplasia in patients with Barrett esophagus: a prospective study.
abstract: 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.
authors.affiliation: General Surgery IV, Regional Referral Center for Esophageal Pathology, Department of Medical and Surgical Gastroenterology, AOU Pisana, Pisa, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rossi
authors.forename: Marco
authors.initials: M
authors.lastname: Barreca
authors.forename: Nicola
authors.initials: N
authors.lastname: de Bortoli
authors.forename: Cristina
authors.initials: C
authors.lastname: Renzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Santi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gennai
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellini
authors.forename: Francesco
authors.initials: F
authors.lastname: Costa
authors.forename: Massimo
authors.initials: M
authors.lastname: Conio
authors.forename: Santino
authors.initials: S
authors.lastname: Marchi
mesh_terms: 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
chemical_list: D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D009853:Omeprazole