Acid suppression and surgical therapy for Barrett's oesophagus.
Gastro-oesophageal reflux disease is a common medical problem in developed countries, and is a risk factor for the development of Barrett's oesophagus and oesophageal adenocarcinoma. Both proton pump inhibitor therapy and antireflux surgery are effective at controlling endoscopic signs and symptoms of gastro-oesophageal reflux in patients with Barrett's oesophagus, but often fail to eliminate pathological oesophageal acid exposure. The current available studies strongly suggest that acid suppressive therapy, both pharmacological as well as surgical acid suppression, can reduce the risk the development and progression in patients with Barrett's oesophagus, but are not capable of complete prevention. No significant differences have been found between pharmacological and surgical therapy. For clinical practice, patients should be prescribed a proton pump inhibitor once daily as maintenance therapy, with the dose guided by symptoms. Antireflux surgery can be a good alternative to proton pump inhibitor therapy, but should be primarily offered to patients with symptomatic reflux, and not to asymptomatic patients with the rationale to protect against cancer.
Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, The Netherlands. Electronic address: p.dejonge@erasmusmc.nl.
Pieter J F
PJ
de Jonge
Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, The Netherlands.
Manon C
MC
Spaander
Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, The Netherlands.
Marco J
MJ
Bruno
Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, The Netherlands.
Ernst J
EJ
Kuipers
D000230:Adenocarcinoma / Q000209:etiology / Q000517:prevention & control; D001471:Barrett Esophagus / Q000209:etiology / Q000517:prevention & control*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000209:etiology / Q000517:prevention & control; D004943:Esophagogastric Junction / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors
D054328:Proton Pump Inhibitors
Acid inhibition; Antireflux surgery; Barrett's oesophagus; Gastro-oesophageal reflux disease; Oesophageal adenocarcinoma; Proton pump inhibitors