BACKGROUND: Endoscopic radiofrequency ablation (RFA) is a promising new treatment of Barrett's esophagus (BE). Adjunctive intra-esophageal pH control with proton pump inhibitors and/or anti-reflux surgery is generally recommended to optimize squamous re-epithelialization after ablation. AIMS: The aims of this study were to examine the association between intra-esophageal pH control and RFA outcomes and to identify predictive factors to achieve complete elimination (CE) of BE following RFA. METHODS: We retrospectively studied the outcomes of BE patients treated with RFA. Esophageal acid exposure (EAE) was assessed utilizing 24-h pH monitoring on therapy. CE was endoscopically defined as no area suspicious for residual metaplasia following RFA. RESULTS: Of 45 patients (33 men; mean age 61.6, mean BE length C4.1 M4.6) examined for EAE, 29 % exhibited moderate-severe EAE despite therapy. Reduction in BE surface area and CE rate were higher in the normal-mild EAE group compared with the moderate-severe EAE group (99 vs. 95 %, p = 0.02; 44 vs. 15 %, p = 0.09, respectively). Using univariate analysis, age, gender, race, aspirin/NSAIDs use, baseline worst histology, baseline BE surface area, and the number or types of RFA had no correlation with CE. By multivariate multiple logistic regression analysis, normal-mild EAE and smaller hiatal hernia were independent factors associated with CE. CONCLUSIONS: Effective intra-esophageal pH control is associated with improved RFA outcomes of BE. Normal to mild EAE and smaller hiatal hernia are predictive factors to achieve CE. Given the frequent persistence of acid reflux despite therapy in BE patients, in order to maximize the RFA effects esophageal pH optimization and hernia repair should be considered.
BACKGROUND: Endoscopic radiofrequency ablation (RFA) is a promising new treatment of Barrett's esophagus (BE). Adjunctive intra-esophageal pH control with proton pump inhibitors and/or anti-reflux surgery is generally recommended to optimize squamous re-epithelialization after ablation. AIMS: The aims of this study were to examine the association between intra-esophageal pH control and RFA outcomes and to identify predictive factors to achieve complete elimination (CE) of BE following RFA. METHODS: We retrospectively studied the outcomes of BE patients treated with RFA. Esophageal acid exposure (EAE) was assessed utilizing 24-h pH monitoring on therapy. CE was endoscopically defined as no area suspicious for residual metaplasia following RFA. RESULTS: Of 45 patients (33 men; mean age 61.6, mean BE length C4.1 M4.6) examined for EAE, 29 % exhibited moderate-severe EAE despite therapy. Reduction in BE surface area and CE rate were higher in the normal-mild EAE group compared with the moderate-severe EAE group (99 vs. 95 %, p = 0.02; 44 vs. 15 %, p = 0.09, respectively). Using univariate analysis, age, gender, race, aspirin/NSAIDs use, baseline worst histology, baseline BE surface area, and the number or types of RFA had no correlation with CE. By multivariate multiple logistic regression analysis, normal-mild EAE and smaller hiatal hernia were independent factors associated with CE. CONCLUSIONS: Effective intra-esophageal pH control is associated with improved RFA outcomes of BE. Normal to mild EAE and smaller hiatal hernia are predictive factors to achieve CE. Given the frequent persistence of acid reflux despite therapy in BE patients, in order to maximize the RFA effects esophageal pH optimization and hernia repair should be considered.
Authors: Prateek Sharma; John Dent; David Armstrong; Jacques J G H M Bergman; Liebwin Gossner; Yoshio Hoshihara; Janusz A Jankowski; Ola Junghard; Lars Lundell; Guido N J Tytgat; Michael Vieth Journal: Gastroenterology Date: 2006-08-16 Impact factor: 22.682
Authors: Virender K Sharma; H Jae Kim; Ananya Das; Christopher D Wells; Cuong C Nguyen; David E Fleischer Journal: Am J Gastroenterol Date: 2009-01-27 Impact factor: 10.864
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Authors: Sachin Wani; V Raman Muthusamy; Nicholas J Shaheen; Rena Yadlapati; Robert Wilson; Julian A Abrams; Jacques Bergman; Amitabh Chak; Kenneth Chang; Ananya Das; John Dumot; Steven A Edmundowicz; Glenn Eisen; Gary W Falk; M Brian Fennerty; Lauren Gerson; Gregory G Ginsberg; David Grande; Matt Hall; Ben Harnke; John Inadomi; Janusz Jankowski; Charles J Lightdale; Jitin Makker; Robert D Odze; Oliver Pech; Richard E Sampliner; Stuart Spechler; George Triadafilopoulos; Michael B Wallace; Kenneth Wang; Irving Waxman; Srinadh Komanduri Journal: Am J Gastroenterol Date: 2017-06-01 Impact factor: 10.864
Authors: Leandi Krüger; Liara M Gonzalez; Tiffany A Pridgen; Shannon J McCall; Richard J von Furstenberg; Ivan Harnden; Gwendolyn E Carnighan; Abigail M Cox; Anthony T Blikslager; Katherine S Garman Journal: Am J Physiol Gastrointest Liver Physiol Date: 2017-06-01 Impact factor: 4.052
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