Document Detail


Increased risk for persistent intestinal metaplasia in patients with Barrett's esophagus and uncontrolled reflux exposure before radiofrequency ablation.
MedLine Citation:
PMID:  22609385     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Radiofrequency ablation (RFA) is a safe alternative to esophagectomy for patients with dysplastic Barrett's esophagus (BE). Although some studies have indicated that RFA is effective at eradicating dysplasia, most have found that RFA is not as effective in eradicating intestinal metaplasia. We investigated whether uncontrolled reflux is associated with persistent intestinal metaplasia after RFA.
METHODS: Thirty-seven patients with BE underwent RFA, high-resolution manometry, and 24-hour impedance-pH testing; they received proton pump inhibitors twice daily. Patients returned every 2 months for repeat treatment or standard surveillance. Patients were classified as complete responders (CRs) if all intestinal metaplasia was eradicated in fewer than 3 ablation sessions. We analyzed clinical parameters to identify factors associated with a CR or incomplete responder (ICR).
RESULTS: Among the 37 patients, 22 had a CR and 15 had an ICR. Mann-Whitney U tests revealed that length of BE, size of hiatal hernia, and frequency of reflux, but not acid reflux, differed between CRs and ICRs. CRs had fewer weakly acidic events than ICRs (29.5 vs 52; P < .05) and total reflux events (33.5 vs 60; P < .05), and a trend toward fewer weakly alkaline events (1.0 vs 5.0; P = .06). No other clinical or manometric features differed between groups.
CONCLUSIONS: Uncontrolled, predominantly weakly acidic reflux despite twice-daily proton pump inhibitor therapy before RFA increases the incidence of persistent intestinal metaplasia after ablation in patients with BE. Length of BE and size of hiatal hernia also were associated with persistent intestinal metaplasia after RFA.
Authors:
Kumar Krishnan; John E Pandolfino; Peter J Kahrilas; Laurie Keefer; Lubomyr Boris; Srinadh Komanduri
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-05-15
Journal Detail:
Title:  Gastroenterology     Volume:  143     ISSN:  1528-0012     ISO Abbreviation:  Gastroenterology     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-28     Completed Date:  2012-11-06     Revised Date:  2013-09-03    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  576-81     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60605, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Barrett Esophagus / complications,  pathology,  surgery*
Biopsy
Catheter Ablation* / adverse effects
Chicago
Electric Impedance
Endoscopy, Gastrointestinal
Esophagus / pathology,  surgery*
Gastric Acidity Determination
Gastroesophageal Reflux / complications*,  drug therapy,  pathology
Hernia, Hiatal / complications,  pathology
Humans
Manometry
Metaplasia
Middle Aged
Predictive Value of Tests
Proton Pump Inhibitors / administration & dosage
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
R01 DK056033/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK56033/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Proton Pump Inhibitors
Comments/Corrections
Comment In:
Gastroenterology. 2012 Sep;143(3):524-6   [PMID:  22841734 ]
Gastroenterology. 2012 Oct;143(4):e21-2; author reply e22-3   [PMID:  22921670 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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