[A comparison of medical versus surgical treatment in Barrett's esophagus acid control]

Abstract

Introduction: Barrett's oesophagus (BE) is an oesophageal injury caused by gastroesophageal acid reflux. One of the main aims of treatment in BE is to achieve adequate acid reflux control.

Objective: To assess acid reflux control in patients with BE based on the therapy employed: medical or surgical.

Methods: A retrospective study was performed in patients with an endoscopic and histological diagnosis of BE. Medical therapy with proton pump inhibitors (PPI) was compared with surgical treatment (Nissen fundoplication). Epidemiological data and the results of pH monitoring (pH time <4, prolonged reflux >5min, DeMeester score) were evaluated in each group. Treatment failure was defined as a pH lower than 4 for more than 5% of the recording time.

Results: A total of 128 patients with BE were included (75 PPI-treated and 53 surgically-treated patients). Patients included in the two comparison groups were homogeneous in terms of demographic characteristics. DeMeester scores, fraction of time pH<4 and the number of prolonged refluxes were significantly lower in patients with fundoplication versus those receiving PPIs (P<.001). Treatment failure occurred in 29% of patients and was significantly higher in those receiving medical therapy (40% vs 13%; P<.001).

Conclusions: Treatment results were significantly worse with medical treatment than with anti-reflux surgery and should be optimized to improve acid reflux control in BE. Additional evidence is needed to fully elucidate the utility of PPI in this disease.

Keywords: Acid control; Anti-reflux surgery; Barrett's oesophagus; Cirugía antirreflujo; Control del reflujo ácido; Esófago de Barrett; Funduplicatura de Nissen; Gastroesophageal reflux disease; Inhibidores de la bomba de protones; Nissen fundoplication; Proton pump inhibitors; Reflujo gastroesofágico.