title: Neoplastic progression in short-segment Barrett's oesophagus is associated with impairment of chemical clearance, but not inadequate acid suppression by proton pump inhibitor therapy.
abstract: BACKGROUND
  Pathophysiological mechanisms associated with neoplastic progression in patients with short-segment Barrett's oesophagus (SSBO), who represent the vast majority of the Barrett population, have not been defined.
  
  
  OBJECTIVE
  To evaluate pathophysiological characteristics of patients with SSBO and dysplasia detected at 3-year surveillance endoscopy (incident dysplasia).
  
  
  METHODS
  Patients with SSBO underwent impedance-pH monitoring during heartburn-suppressing PPI therapy. Fifteen patients (12 males, median age 62 years) with incident dysplasia and 50 patients (43 males, median age 59 years) without dysplasia were compared. Impedance-pH parameters, including chemical clearance assessed by the post-reflux swallow-induced peristaltic wave (PSPW) index, were evaluated.
  
  
  RESULTS
  All patients declared persisting heartburn suppression on maintenance PPI therapy at 3-year follow-up, 58/65 (89%) with standard dosages. The median gastric and oesophageal acid exposure time (GAET and OAET) did not differ between patients with and without incident dysplasia at the time of surveillance (36% and 0.6% vs. 33% and 0.5%) or index endoscopy (33% and 0.3% vs. 41% and 0.5%) (P > 0.05). Contrastingly, the median PSPW index was significantly lower in patients with than in patients without incident dysplasia at the time of surveillance (15%, vs. 32%) and index endoscopy (12% vs. 30%) (P = 0.001). The PSPW index, the GAET and the OAET did not vary over time (P > 0.05). A PSPW index <26% was predictive of incident dysplasia with a 75% accuracy.
  
  
  CONCLUSIONS
  Neoplastic progression in SSBO is associated with impairment of chemical clearance, but not inadequate acid suppression by PPI therapy. Neoplastic progression in SSBO can be predicted by a low PSPW index.
authors.affiliation: Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Frazzoni
authors.forename: H
authors.initials: H
authors.lastname: Bertani
authors.forename: R
authors.initials: R
authors.lastname: Conigliaro
authors.forename: L
authors.initials: L
authors.lastname: Frazzoni
authors.forename: L
authors.initials: L
authors.lastname: Losi
authors.forename: G
authors.initials: G
authors.lastname: Melotti
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D004938:Esophageal Neoplasms / Q000209:etiology*; D005260:Female; D005744:Gastric Acid; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000503:physiopathology; D006356:Heartburn / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010528:Peristalsis; D011230:Precancerous Conditions / Q000209:etiology*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
chemical_list: D054328:Proton Pump Inhibitors