title: The patterns of reflux can affect regression of non-dysplastic and low-grade dysplastic Barrett's esophagus after medical and surgical treatment: a prospective case-control study.
abstract: BACKGROUND
  To date, therapeutic guidelines and pattern of reflux for patients with no-dysplasia (ND) or low-grade dysplasia (LGD) Barrett's esophagus (BE) remain unclear. We aimed to analyze pattern of reflux and regression of ND- or LGD-BE after medical and surgical treatment.
  
  
  METHODS
  We studied a cohort of ND- and LGD-BE patients who underwent laparoscopic total fundoplication and a cohort of ND- and LGD-BE patients managed medically. Patients were matched for age, sex, and disease duration. After 1 year of follow-up at least, all patients underwent upper endoscopy with esophageal biopsies to evaluate any histological changes, as well as manometry and impedance-pH-metry to re-assess reflux patterns.
  
  
  RESULTS
  Thirty-seven patients (20 LGD, 17 ND) undergoing laparoscopic fundoplication were enrolled and compared with 25 patients (13 LGD, 12 ND) managed with proton pump inhibitors (PPI). Laparoscopic fundoplication resulted in a better control of both acidic and weakly acidic reflux (P < 0.001) and was associated with a higher probability of reversion for LGD (P < 0.01). Esophageal motility did not differ between surgically and medically treated patients.
  
  
  CONCLUSIONS
  In patients with ND- or LGD-BE, laparoscopic fundoplication seems to warrant a better control of all kinds of refluxate and it is associated with a higher likelihood of reversion of both LGD- and ND-BE, compared with PPI therapy.
authors.affiliation: Division of General and Bariatric Surgery, Department of Surgery, Second University of Naples, Via Pansini, 5, 80131, Naples, NA, Italy, salvatore.tolone@unina2.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.forename: Paolo
authors.initials: P
authors.lastname: Limongelli
authors.forename: Marco
authors.initials: M
authors.lastname: Romano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Federico
authors.forename: Giovanni
authors.initials: G
authors.lastname: Docimo
authors.forename: Roberto
authors.initials: R
authors.lastname: Ruggiero
authors.forename: Luigi
authors.initials: L
authors.lastname: Brusciano
authors.forename: Gianmattia
authors.initials: G
authors.lastname: Del Genio
authors.forename: Ludovico
authors.initials: L
authors.lastname: Docimo
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001706:Biopsy; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D054328:Proton Pump Inhibitors