title: Long-term follow-up of Barrett's epithelium: medical versus antireflux surgical therapy.
abstract: BACKGROUND
  Barrett's esophagus (BE) is the most serious complication of GERD. In BE patients, this observational study compares the effects of antireflux surgery versus antisecretory medical therapy.
  
  
  METHODS
  Overall, 89 BE patients (long BE = 45; short BE = 44) were considered: 45 patients underwent antireflux surgery and 44 underwent medical therapy. At both initial and follow-up endoscopy, symptoms were assessed using a detailed questionnaire; BE phenotypic changes [intestinal metaplasia (IM) presence/type, Cdx2 expression] were assessed by histology (H&E), histochemistry (HID), and immunohistochemistry. Surgical failures were defined as follows: (1) abnormal 24-h pH monitoring results after surgery, (2) endoscopically evident recurrent esophagitis, and (3) recurrent hiatal hernia or slipped fundoplication on endoscopy or barium swallow.
  
  
  RESULTS
  Reversion of IM was observed in 12/44 SSBE and 0/45 LSBE patients (p < 0.01). Reversion was more frequently observed after effective antireflux surgery than after medical treatment (p = 0.04). In patients with no further evidence of IM after therapy, Cdx2 expression was also absent (p = 0.02). The extent of IM was reduced, and the IM phenotype improved in SSBE patients after surgery.
  
  
  CONCLUSIONS
  Patients with short BE (but not those with long BE) may benefit from surgically reducing the esophagus' exposure to GE reflux; among these patients, successful surgery carries a higher IM reversion rate than medical treatment.
authors.affiliation: Department of General Surgery, SS Giovanni e Paolo Hospital, ULSS 12, Venice, Italy. giovanni.zaninotto@unipd.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zaninotto
authors.forename: Paola
authors.initials: P
authors.lastname: Parente
authors.forename: Renato
authors.initials: R
authors.lastname: Salvador
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.forename: Chiara
authors.initials: C
authors.lastname: Tieppo
authors.forename: Nicola
authors.initials: N
authors.lastname: Passuello
authors.forename: Lisa
authors.initials: L
authors.lastname: Zanatta
authors.forename: Matteo
authors.initials: M
authors.lastname: Fassan
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.forename: Mario
authors.initials: M
authors.lastname: Costantini
authors.forename: Claudia
authors.initials: C
authors.lastname: Mescoli
authors.forename: Giorgio
authors.initials: G
authors.lastname: Battaglia
authors.forename: Alberto
authors.initials: A
authors.lastname: Ruol
authors.forename: Ermanno
authors.initials: E
authors.lastname: Ancona
authors.forename: Massimo
authors.initials: M
authors.lastname: Rugge
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D001706:Biopsy; D000071616:CDX2 Transcription Factor; D015331:Cohort Studies; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000209:etiology / Q000473:pathology; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology* / Q000503:physiopathology; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications / Q000175:diagnosis; D018398:Homeodomain Proteins / Q000378:metabolism; D006801:Humans; D008365:Manometry; D008679:Metaplasia; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D000071616:CDX2 Transcription Factor; C491270:CDX2 protein, human; D018398:Homeodomain Proteins; D054328:Proton Pump Inhibitors
references.citation: Am J Gastroenterol. 2002 Mar;97(3):554-60
references.pmid: 11922546
references.citation: Arch Surg. 2009 Oct;144(10):921-7
references.pmid: 19841359
references.citation: Am J Surg. 2004 Jul;188(1):27-33
references.pmid: 15219481
references.citation: Surg Endosc. 2007 Jan;21(1):11-5
references.pmid: 17111285
references.citation: Gastrointest Endosc. 1996 Nov;44(5):532-5
references.pmid: 8934157
references.citation: Am J Gastroenterol. 1992 Sep;87(9):1102-11
references.pmid: 1519566
references.citation: Dig Liver Dis. 2000 Jan-Feb;32(1):46-55
references.pmid: 10975755
references.citation: J Exp Clin Cancer Res. 2009 Aug 07;28:108
references.pmid: 19664209
references.citation: Am J Gastroenterol. 2007 Mar;102(3):497-506
references.pmid: 17156135
references.citation: J Gastrointest Surg. 2002 Jul-Aug;6(4):532-8; discussion 539
references.pmid: 12127118
references.citation: Histopathology. 1979 May;3(3):191-9
references.pmid: 468122
references.citation: J Am Coll Surg. 2003 May;196(5):706-12; discussion 712-3
references.pmid: 12742201
references.citation: Am J Physiol Gastrointest Liver Physiol. 2008 Aug;295(2):G211-8
references.pmid: 18556417
references.citation: Mod Pathol. 2004 Oct;17(10):1282-8
references.pmid: 15167938
references.citation: Am J Gastroenterol. 1997 Apr;92(4):586-91
references.pmid: 9128304
references.citation: Z Gastroenterol. 2000 Jul;38(7):565-70
references.pmid: 10965553
references.citation: Ann Surg. 2000 Mar;231(3):303-21
references.pmid: 10714623
references.citation: Hum Pathol. 2010 Oct;41(10):1380-6
references.pmid: 20656315
references.citation: Am J Physiol Gastrointest Liver Physiol. 2000 Jun;278(6):G1000-9
references.pmid: 10859231
references.citation: Am J Surg Pathol. 2003 Nov;27(11):1442-7
references.pmid: 14576477
references.citation: Scand J Gastroenterol Suppl. 2003;(239):40-3
references.pmid: 14743882
references.citation: J Gastrointest Surg. 2005 Dec;9(9):1253-60; discussion 1260-1
references.pmid: 16332481
references.citation: Ann Surg. 2003 Oct;238(4):458-64; discussion 464-6
references.pmid: 14530718
references.citation: Dis Esophagus. 2006;19(5):360-5
references.pmid: 16984533
references.citation: Gastroenterology. 2002 May;122(6):1569-91
references.pmid: 12016424
references.citation: World J Surg. 2004 Feb;28(2):148-54
references.pmid: 14727064
references.citation: Gut. 1999 Aug;45(2):172-80
references.pmid: 10403727
references.citation: Am J Surg Pathol. 2000 Feb;24(2):167-76
references.pmid: 10680883
references.citation: J Gastrointest Surg. 1997 Mar-Apr;1(2):113-22
references.pmid: 9834337
references.citation: Dig Liver Dis. 2002 Apr;34(4):251-7
references.pmid: 12038808
references.citation: Curr Opin Gastroenterol. 2007 Jul;23(4):452-5
references.pmid: 17545785