Back to Search
Start Over
Reflux control is important in the management of Barrett's Esophagus: results from a retrospective 1,830 patient cohort.
- Source :
-
Surgical Endoscopy & Other Interventional Techniques . Dec2015, Vol. 29 Issue 12, p3528-3534. 7p. 1 Diagram, 4 Charts. - Publication Year :
- 2015
-
Abstract
- <bold>Background: </bold>It is unknown whether acid/reflux control prevents progression in Barrett's esophagus. In this study, we investigate whether medical or surgical control of reflux is associated with a decreased risk of progression to dysplasia/esophageal adenocarcinoma.<bold>Methods: </bold>We retrospectively collected and analyzed data from a cohort of Barrett's esophagus patients participating in this single-center study comprised of all patients diagnosed with Barrett's esophagus at NorthShore University Health System hospitals and clinics over a 10-year period. Patients were followed in order to identify those progressing from Barrett's esophagus to low-grade dysplasia, high-grade dysplasia, and esophageal adenocarcinoma. We collected information from the patient's electronic medical records regarding demographic, endoscopic findings, histological findings, smoking/alcohol history, medication use including proton-pump inhibitors, and history of bariatric and antireflux surgery. Risk-adjusted modeling was performed using multivariable logistic regression.<bold>Results: </bold>This study included 1,830 total Barrett's esophagus patients, 102 of which had their Barrett's esophagus progress to low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma (confirmed by biopsy) with an annual incidence rate of 1.1%. Mean follow-up period was 5.51 years (10,083 patient-years). Compared to the group that did not progress, the group that progressed was older (69.3 ± 13.7 vs. 63.9 ± 13.4 years. p < 0.001) and likely to be male (75 vs. 61%, p < 0.01). In the multivariable analysis, patients who had a history of antireflux surgery (n = 44) or proton-pump inhibitor use without surgery (n = 1,641) were found to progress at significantly lower rates than patients who did not have antireflux surgery or were not taking PPI's (OR 0.18, 95% CI 0.09-0.36).<bold>Conclusions: </bold>Reflux control was associated with decreased risk of progression to low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma. These results support the use of reflux control strategies such as proton-pump inhibitor therapy or surgery in patients with non-dysplastic Barrett's esophagus for the prevention of progression to dysplasia/adenocarcinoma. [ABSTRACT FROM AUTHOR]
- Subjects :
- *GASTROESOPHAGEAL reflux
*BARRETT'S esophagus
*CANCER treatment
*ADENOCARCINOMA
*PROTON pump inhibitors
*LOGISTIC regression analysis
*THERAPEUTICS
*ACE inhibitors
*ESOPHAGEAL tumors
*VITAMIN D
*DISEASE incidence
*RETROSPECTIVE studies
*DISEASE progression
*NEOPLASTIC cell transformation
*DISEASE complications
*PREVENTION
Subjects
Details
- Language :
- English
- ISSN :
- 18666817
- Volume :
- 29
- Issue :
- 12
- Database :
- Academic Search Index
- Journal :
- Surgical Endoscopy & Other Interventional Techniques
- Publication Type :
- Academic Journal
- Accession number :
- 111004843
- Full Text :
- https://doi.org/10.1007/s00464-015-4103-3