title: Increased risk for persistent intestinal metaplasia in patients with Barrett's esophagus and uncontrolled reflux exposure before radiofrequency ablation.
abstract: OBJECTIVE
  Radiofrequency ablation (RFA) is a safe alternative to esophagectomy for patients with dysplastic Barrett's esophagus (BE). Although some studies have indicated that RFA is effective at eradicating dysplasia, most have found that RFA is not as effective in eradicating intestinal metaplasia. We investigated whether uncontrolled reflux is associated with persistent intestinal metaplasia after RFA.
  
  
  METHODS
  Thirty-seven patients with BE underwent RFA, high-resolution manometry, and 24-hour impedance-pH testing; they received proton pump inhibitors twice daily. Patients returned every 2 months for repeat treatment or standard surveillance. Patients were classified as complete responders (CRs) if all intestinal metaplasia was eradicated in fewer than 3 ablation sessions. We analyzed clinical parameters to identify factors associated with a CR or incomplete responder (ICR).
  
  
  RESULTS
  Among the 37 patients, 22 had a CR and 15 had an ICR. Mann-Whitney U tests revealed that length of BE, size of hiatal hernia, and frequency of reflux, but not acid reflux, differed between CRs and ICRs. CRs had fewer weakly acidic events than ICRs (29.5 vs 52; P < .05) and total reflux events (33.5 vs 60; P < .05), and a trend toward fewer weakly alkaline events (1.0 vs 5.0; P = .06). No other clinical or manometric features differed between groups.
  
  
  CONCLUSIONS
  Uncontrolled, predominantly weakly acidic reflux despite twice-daily proton pump inhibitor therapy before RFA increases the incidence of persistent intestinal metaplasia after ablation in patients with BE. Length of BE and size of hiatal hernia also were associated with persistent intestinal metaplasia after RFA.
authors.affiliation: Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Kumar
authors.initials: K
authors.lastname: Krishnan
authors.affiliation: Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; "Motts" Tonelli Esophageal Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
authors.affiliation: Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; "Motts" Tonelli Esophageal Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
authors.affiliation: Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Laurie
authors.initials: L
authors.lastname: Keefer
authors.affiliation: "Motts" Tonelli Esophageal Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Lubomyr
authors.initials: L
authors.lastname: Boris
authors.affiliation: Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; "Motts" Tonelli Esophageal Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: sri-komanduri@northwestern.edu.
authors.forename: Srinadh
authors.initials: S
authors.lastname: Komanduri
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D017115:Catheter Ablation / Q000009:adverse effects; D002641:Chicago; D017097:Electric Impedance; D016099:Endoscopy, Gastrointestinal; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006551:Hernia, Hiatal / Q000150:complications / Q000473:pathology; D006801:Humans; D008365:Manometry; D008679:Metaplasia; D008875:Middle Aged; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors