PMID- 24074425
OWN - NLM
STAT- MEDLINE
DCOM- 20131126
LR  - 20130930
IS  - 1532-7361 (Electronic)
IS  - 0039-6060 (Linking)
VI  - 154
IP  - 4
DP  - 2013 Oct
TI  - Gastroesophageal reflux disease, proton-pump inhibitor use and Barrett's 
      esophagus in esophageal adenocarcinoma: Trends revisited.
PG  - 856-64; discussion 864-6
LID - S0039-6060(13)00422-4 [pii]
LID - 10.1016/j.surg.2013.07.020 [doi]
AB  - PURPOSE: Screening for esophageal adenocarcinoma (EAC) has not become policy in 
      part over concerns in identifying the high-risk group. It is often claimed that a 
      significant proportion of patients developing EAC do not report preexisting 
      reflux symptoms or prior treatment for gastroesophageal reflux disease (GERD). As 
      such, our aim was to assess the prevalence of GERD symptoms, proton pump 
      inhibitor (PPI) use and Barrett's esophagus (BE) and their impact on survival in 
      patients undergoing esophagectomy for EAC. METHODS: The study population 
      consisted of 345 consecutive patients who underwent esophagectomy for EAC between 
      2000 and 2011 at a university-based medical center. Patients with a diagnosis of 
      esophageal squamous cell carcinoma and those who underwent esophagectomy for 
      benign disease were excluded. The prevalence of preoperative GERD symptoms, 
      defined as presence of heartburn, regurgitation or epigastric pain, PPI use (>6 
      months) and BE, defined by the phrases "Barrett's esophagus," "intestinal 
      epithelium," "specialized epithelium," or "goblet cell metaplasia" in the 
      patients' preoperative clinical notes were retrospectively collected. Overall 
      long-term and stage-specific survival was compared in patients with and without 
      the presence of preoperative GERD symptoms, PPI use, or BE. RESULTS: The majority 
      of patients (64%; 221/345) had preoperative GERD symptoms and a history of PPI 
      use (52%; 179/345). A preoperative diagnosis of BE was present in 34% (118/345) 
      of patients. Kaplan-Meier survival analysis revealed a marked survival advantage 
      in patients undergoing esophagectomy who had preoperative GERD symptoms, PPI use 
      or BE diagnosis (P </= .001). The survival advantage remained when stratified for 
      American Joint Committee on Cancer stage in patients with preoperative PPI use (P 
      = .015) but was less pronounced in patients with GERD symptoms or BE (P = .136 
      and P = .225, respectively). CONCLUSION: These data show that the oft-quoted 
      statistic that the majority of patients with EAC do not report preexisting GERD 
      or PPI use is false. Furthermore, a diagnosis of BE is present in a surprisingly 
      high proportion of patients (34%). There is a distinct survival advantage in 
      patients with preoperative GERD symptoms, PPI use, and BE diagnosis, which may 
      not be simply owing to earlier stage at diagnosis. Screening may affect survival 
      outcomes in more patients with EAC than previously anticipated.
CI  - Copyright (c) 2013 Mosby, Inc. All rights reserved.
FAU - Lada, Michal J
AU  - Lada MJ
AD  - Division of Thoracic and Foregut Surgery, Department of Surgery, University of 
      Rochester Medical Center, Rochester, NY.
FAU - Nieman, Dylan R
AU  - Nieman DR
FAU - Han, Michelle
AU  - Han M
FAU - Timratana, Poochong
AU  - Timratana P
FAU - Alsalahi, Omran
AU  - Alsalahi O
FAU - Peyre, Christian G
AU  - Peyre CG
FAU - Jones, Carolyn E
AU  - Jones CE
FAU - Watson, Thomas J
AU  - Watson TJ
FAU - Peters, Jeffrey H
AU  - Peters JH
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Surgery
JT  - Surgery
JID - 0417347
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adenocarcinoma/*etiology/mortality/surgery
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Barrett Esophagus/*complications
MH  - Esophageal Neoplasms/*etiology/mortality/surgery
MH  - Female
MH  - Gastroesophageal Reflux/*complications
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Retrospective Studies
MH  - Risk Factors
EDAT- 2013/10/01 06:00
MHDA- 2013/12/16 06:00
CRDT- 2013/10/01 06:00
PHST- 2013/03/07 00:00 [received]
PHST- 2013/07/19 00:00 [accepted]
PHST- 2013/10/01 06:00 [entrez]
PHST- 2013/10/01 06:00 [pubmed]
PHST- 2013/12/16 06:00 [medline]
AID - S0039-6060(13)00422-4 [pii]
AID - 10.1016/j.surg.2013.07.020 [doi]
PST - ppublish
SO  - Surgery. 2013 Oct;154(4):856-64; discussion 864-6. doi: 
      10.1016/j.surg.2013.07.020.