title: Effective intra-esophageal acid control is associated with improved radiofrequency ablation outcomes in Barrett's esophagus.
abstract: BACKGROUND
  Endoscopic radiofrequency ablation (RFA) is a promising new treatment of Barrett's esophagus (BE). Adjunctive intra-esophageal pH control with proton pump inhibitors and/or anti-reflux surgery is generally recommended to optimize squamous re-epithelialization after ablation.
  
  
  OBJECTIVE
  The aims of this study were to examine the association between intra-esophageal pH control and RFA outcomes and to identify predictive factors to achieve complete elimination (CE) of BE following RFA.
  
  
  METHODS
  We retrospectively studied the outcomes of BE patients treated with RFA. Esophageal acid exposure (EAE) was assessed utilizing 24-h pH monitoring on therapy. CE was endoscopically defined as no area suspicious for residual metaplasia following RFA.
  
  
  RESULTS
  Of 45 patients (33 men; mean age 61.6, mean BE length C4.1 M4.6) examined for EAE, 29 % exhibited moderate-severe EAE despite therapy. Reduction in BE surface area and CE rate were higher in the normal-mild EAE group compared with the moderate-severe EAE group (99 vs. 95 %, p = 0.02; 44 vs. 15 %, p = 0.09, respectively). Using univariate analysis, age, gender, race, aspirin/NSAIDs use, baseline worst histology, baseline BE surface area, and the number or types of RFA had no correlation with CE. By multivariate multiple logistic regression analysis, normal-mild EAE and smaller hiatal hernia were independent factors associated with CE.
  
  
  CONCLUSIONS
  Effective intra-esophageal pH control is associated with improved RFA outcomes of BE. Normal to mild EAE and smaller hiatal hernia are predictive factors to achieve CE. Given the frequent persistence of acid reflux despite therapy in BE patients, in order to maximize the RFA effects esophageal pH optimization and hernia repair should be considered.
authors.affiliation: El Camino GI Medical Associates, 2490 Hospital Drive, Suite 211, Mountain View, CA 94040, USA.
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Marcus
authors.forename: George
authors.initials: G
authors.lastname: Triadafilopoulos
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation; D015331:Cohort Studies; D005260:Female; D018662:Fundoplication; D005744:Gastric Acid; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D054328:Proton Pump Inhibitors