| Increased risk for persistent intestinal metaplasia in patients with Barrett's esophagus and uncontrolled reflux exposure before radiofrequency ablation. | |
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MedLine Citation:
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PMID: 22609385 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Kumar Krishnan; John E Pandolfino; Peter J Kahrilas; Laurie Keefer; Lubomyr Boris; Srinadh Komanduri |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2012-05-15 |
Journal Detail:
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Title: Gastroenterology Volume: 143 ISSN: 1528-0012 ISO Abbreviation: Gastroenterology Publication Date: 2012 Sep |
Date Detail:
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Created Date: 2012-08-28 Completed Date: 2012-11-06 Revised Date: 2013-04-16 |
Medline Journal Info:
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Nlm Unique ID: 0374630 Medline TA: Gastroenterology Country: United States |
Other Details:
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Languages: eng Pagination: 576-81 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60605, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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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:
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0/Proton Pump Inhibitors |
| Comments/Corrections | |
Comment In:
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Gastroenterology. 2012 Oct;143(4):e21-2; author reply e22-3
[PMID:
22921670
]
Gastroenterology. 2012 Sep;143(3):524-6 [PMID: 22841734 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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