PMID- 12742201
OWN - NLM
STAT- MEDLINE
DCOM- 20030602
LR  - 20131121
IS  - 1072-7515 (Print)
IS  - 1072-7515 (Linking)
VI  - 196
IP  - 5
DP  - 2003 May
TI  - Barrett's esophagus can and does regress after antireflux surgery: a study of 
      prevalence and predictive features.
PG  - 706-12; discussion 712-3
AB  - BACKGROUND: To investigate the factors leading to histologic regression of 
      metaplastic and dysplastic Barrett's esophagus (BE). STUDY DESIGN: The study 
      sample consisted of 91 consecutive patients with symptomatic Barrett's esophagus. 
      Pre- and posttreatment endoscopic biopsies from 77 Barrett's patients treated 
      surgically and 14 treated with proton pump inhibitors (PPI) were reviewed. An 
      expert pathologist confirmed the presence of intestinal metaplasia (IM) with or 
      without dysplasia. Posttreatment histology was classified as having regressed if 
      two consecutive biopsies taken more than 6 months apart plus all subsequent 
      biopsies showed loss of IM or loss of dysplasia. Clinical factors associated with 
      regression were studied by multivariate analysis, as was the time course of its 
      occurrence. RESULTS: Histopathologic regression occurred in 28 of 77 patients 
      (36.4%) after antireflux surgery and in 1 of 14 patients (7.1%) treated with PPIs 
      alone (p < 0.03). After surgery, regression from low-grade dysplastic to 
      nondysplastic BE occurred in 17 of 25 patients (68%) and from IM to no IM in 11 
      of 52 (21.2%). Both types of regression were significantly more common in short 
      (< 3 cm) than long (> 3 cm) segment Barrett's esophagus; 19 of 33 (58%) and 9 of 
      44 (20%) patients, respectively (p = 0.0016). Eight patients progressed, five 
      from IM alone to low-grade dysplasia and three from low- to high-grade dysplasia. 
      All those who progressed had long segment BE. On multivariate analysis, presence 
      of short segment Barrett's and type of treatment were significantly associated 
      with regression; age, gender, surgical procedure, and preoperative lower 
      esophageal sphincter and pH characteristics were not. The median time of 
      biopsy-proved regression was 18.5 months after surgery, with 95% occurring within 
      5 years. CONCLUSIONS: This study refutes the widely held assumption that once 
      established, Barrett's esophagus does not change. More than one-third of patients 
      with visible segments of Barrett's esophagus undergo histologic regression after 
      antireflux surgery. Regression is dependent on the length of the columnar-lined 
      esophagus and time of followup after antireflux surgery.
FAU - Gurski, Richard R
AU  - Gurski RR
AD  - Department of Surgery, Division of Thoracic and Foregut Surgery, University of 
      Southern California, Los Angeles, CA 90033, USA.
FAU - Peters, Jeffrey H
AU  - Peters JH
FAU - Hagen, Jeffrey A
AU  - Hagen JA
FAU - DeMeester, Steven R
AU  - DeMeester SR
FAU - Bremner, Cedric G
AU  - Bremner CG
FAU - Chandrasoma, Parakrama T
AU  - Chandrasoma PT
FAU - DeMeester, Tom R
AU  - DeMeester TR
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Am Coll Surg
JT  - Journal of the American College of Surgeons
JID - 9431305
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
CIN - J Am Coll Surg. 2003 Nov;197(5):882-3. PMID: 14585434
CIN - Gastroenterology. 2004 Jan;126(1):351-2; discussion 352-3. PMID: 14699514
MH  - Barrett Esophagus/*pathology/*surgery
MH  - Biopsy
MH  - Esophagus/pathology
MH  - Female
MH  - Follow-Up Studies
MH  - Gastroesophageal Reflux/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Prevalence
MH  - Proton Pump Inhibitors
MH  - Time Factors
EDAT- 2003/05/14 05:00
MHDA- 2003/06/05 05:00
CRDT- 2003/05/14 05:00
PHST- 2003/05/14 05:00 [pubmed]
PHST- 2003/06/05 05:00 [medline]
PHST- 2003/05/14 05:00 [entrez]
AID - S1072-7515(03)00147-9 [pii]
AID - 10.1016/S1072-7515(03)00147-9 [doi]
PST - ppublish
SO  - J Am Coll Surg. 2003 May;196(5):706-12; discussion 712-3. doi: 
      10.1016/S1072-7515(03)00147-9.