title: [Comparison of surgical patients with gastroesophageal reflux disease and Barrett's esophagus].
abstract: BACKGROUND
  Barrett's esophagus (BE) is the only known precursor of adenocarcinoma occuring in the lower third of the esophagus. According to statistics, severity and elapsed time of gastroesophageal reflux disease (GERD) are major pathogenetic factors in the development of Barrett's esophagus.
  
  
  METHODS
  In a retrospective study between 2001 and 2008, we compared the preoperative results (signs and sympthoms, 24 hour pH manometry, esophageal manometry, Bilitec) and treatment efficacy of 176 GERD patients and 78 BE patients, who have undergone laparoscopic Nissen procedure for reflux disease.
  
  
  RESULTS
  The two groups of patients had similar demographic features, and elapsed time of reflux sympthoms were also equal. Both groups were admitted for surgery after a median time of 1.5 years (19.87 vs. 19.20 months) of ineffective medical (proton pump inhibitors) treatment. Preoperative functional tests showed a more severe presence of acid reflux in the BE group (DeMeester score 18.9 versus 41.9, p < 0.001). On the other hand, mano-metry - despite confirming lower esophageal sphincter (LES) damage - did not show difference between the two groups (12.10 vs. 12.57 mmHg, p = 0.892). We did not experience any mortality cases with laparoscopic antireflux procedures, although in two cases we had to convert during the operation (1 due to extensive adhesions, and 1 due to injury to the spleen). 3 months after the procedure - according to Visick score - both groups experienced a significant decrease, or lapse in reflux complaints (group I: 73%, group II: 81% of patients), LES functions improved (17.58 vs.18.70 mmHg), and the frequency and exposition of acid reflux decreased (DeMeester score 7.73 vs. 12.72).
  
  
  CONCLUSIONS
  The severity of abnormal acid reflux occuring parallel with the incompetent function of the damaged LES triggers not only inflammation in the gastroesophageal junction (GEJ), but also metaplastic process, and the development of Barrett's esophagus. Laparoscopic Nissen procedure for reflux disease can further improve outcome among patients with GERD not responding to conservative therapy.
authors.affiliation: Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.
authors.forename: Simonka
authors.initials: S
authors.lastname: Zsolt
authors.affiliation: Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.
authors.forename: Attila
authors.initials: A
authors.lastname: Paszt
authors.affiliation: Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.
authors.forename: Tibor
authors.initials: T
authors.lastname: Géczi
authors.affiliation: Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Abrahám
authors.affiliation: Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.
authors.forename: Illés
authors.initials: I
authors.lastname: Tóth
authors.affiliation: Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Horváth
authors.affiliation: Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.
authors.forename: József
authors.initials: J
authors.lastname: Pieler
authors.affiliation: Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.
authors.forename: János
authors.initials: J
authors.lastname: Tajti
authors.affiliation: Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.
authors.forename: Akos
authors.initials: A
authors.lastname: Varga
authors.affiliation: Szegedi Tudományegyetem Patológiai Intézet Szeged.
authors.forename: László
authors.initials: L
authors.lastname: Tiszlavicz
authors.affiliation: Szegedi Tudományegyetem Patológiai Intézet Szeged.
authors.forename: István
authors.initials: I
authors.lastname: Németh
authors.affiliation: Szegedi Tudományegyetem I. Sz. Belgyógyászati Klinika Szeged.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Izbéki
authors.affiliation: Szegedi Tudományegyetem I. Sz. Belgyógyászati Klinika Szeged.
authors.forename: András
authors.initials: A
authors.lastname: Rosztóczy
authors.affiliation: Szegedi Tudományegyetem I. Sz. Belgyógyászati Klinika Szeged.
authors.forename: Tibor
authors.initials: T
authors.lastname: Wittmann
authors.affiliation: Szegedi Tudományegyetem Sebészeti Klinika 6725 Szeged Pf. 427.
authors.forename: György
authors.initials: G
authors.lastname: Lázár
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000209:etiology / Q000517:prevention & control; D005260:Female; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D019518:Postprandial Period; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D054328:Proton Pump Inhibitors
keywords: Barrett-nyelőcső; Barrett’s esophagus; antireflux műtét; antireflux procedure; laparoscopic Nissen fundoplication; laparoscopos Nissen-fundoplicatio; reflux disease; refluxbetegség (gastrooesophagealis refluxbetegség)