Craig S Brown1,2, Brittany Lapin3, Chi Wang3, Jay L Goldstein3, John G Linn3, Woody Denham3, Stephen P Haggerty3, Mark S Talamonti3, John A Howington3, Joann Carbray3, Michael B Ujiki4. 1. Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA. craigb@uchicago.edu. 2. Pritzker School of Medicine, University of Chicago, Chicago, IL, 60637, USA. craigb@uchicago.edu. 3. Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA. 4. Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave., Suite B665, Evanston, IL, 60201, USA. mujiki@northshore.org.
Abstract
BACKGROUND: It is unknown whether acid/reflux control prevents progression in Barrett's esophagus. In this study, we investigate whether medical or surgical control of reflux is associated with a decreased risk of progression to dysplasia/esophageal adenocarcinoma. METHODS: We retrospectively collected and analyzed data from a cohort of Barrett's esophagus patients participating in this single-center study comprised of all patients diagnosed with Barrett's esophagus at NorthShore University Health System hospitals and clinics over a 10-year period. Patients were followed in order to identify those progressing from Barrett's esophagus to low-grade dysplasia, high-grade dysplasia, and esophageal adenocarcinoma. We collected information from the patient's electronic medical records regarding demographic, endoscopic findings, histological findings, smoking/alcohol history, medication use including proton-pump inhibitors, and history of bariatric and antireflux surgery. Risk-adjusted modeling was performed using multivariable logistic regression. RESULTS: This study included 1,830 total Barrett's esophagus patients, 102 of which had their Barrett's esophagus progress to low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma (confirmed by biopsy) with an annual incidence rate of 1.1%. Mean follow-up period was 5.51 years (10,083 patient-years). Compared to the group that did not progress, the group that progressed was older (69.3 ± 13.7 vs. 63.9 ± 13.4 years. p < 0.001) and likely to be male (75 vs. 61%, p < 0.01). In the multivariable analysis, patients who had a history of antireflux surgery (n = 44) or proton-pump inhibitor use without surgery (n = 1,641) were found to progress at significantly lower rates than patients who did not have antireflux surgery or were not taking PPI's (OR 0.18, 95% CI 0.09-0.36). CONCLUSIONS: Reflux control was associated with decreased risk of progression to low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma. These results support the use of reflux control strategies such as proton-pump inhibitor therapy or surgery in patients with non-dysplastic Barrett's esophagus for the prevention of progression to dysplasia/adenocarcinoma.
BACKGROUND: It is unknown whether acid/reflux control prevents progression in Barrett's esophagus. In this study, we investigate whether medical or surgical control of reflux is associated with a decreased risk of progression to dysplasia/esophageal adenocarcinoma. METHODS: We retrospectively collected and analyzed data from a cohort of Barrett's esophagus patients participating in this single-center study comprised of all patients diagnosed with Barrett's esophagus at NorthShore University Health System hospitals and clinics over a 10-year period. Patients were followed in order to identify those progressing from Barrett's esophagus to low-grade dysplasia, high-grade dysplasia, and esophageal adenocarcinoma. We collected information from the patient's electronic medical records regarding demographic, endoscopic findings, histological findings, smoking/alcohol history, medication use including proton-pump inhibitors, and history of bariatric and antireflux surgery. Risk-adjusted modeling was performed using multivariable logistic regression. RESULTS: This study included 1,830 total Barrett's esophagus patients, 102 of which had their Barrett's esophagus progress to low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma (confirmed by biopsy) with an annual incidence rate of 1.1%. Mean follow-up period was 5.51 years (10,083 patient-years). Compared to the group that did not progress, the group that progressed was older (69.3 ± 13.7 vs. 63.9 ± 13.4 years. p < 0.001) and likely to be male (75 vs. 61%, p < 0.01). In the multivariable analysis, patients who had a history of antireflux surgery (n = 44) or proton-pump inhibitor use without surgery (n = 1,641) were found to progress at significantly lower rates than patients who did not have antireflux surgery or were not taking PPI's (OR 0.18, 95% CI 0.09-0.36). CONCLUSIONS: Reflux control was associated with decreased risk of progression to low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma. These results support the use of reflux control strategies such as proton-pump inhibitor therapy or surgery in patients with non-dysplastic Barrett's esophagus for the prevention of progression to dysplasia/adenocarcinoma.
Authors: M Sikkema; C W N Looman; E W Steyerberg; M Kerkhof; F Kastelein; H van Dekken; A J van Vuuren; W A Bode; H van der Valk; R J T Ouwendijk; R Giard; W Lesterhuis; R Heinhuis; E C Klinkenberg; G A Meijer; F ter Borg; J W Arends; J J Kolkman; J van Baarlen; R A de Vries; A H Mulder; A J P van Tilburg; G J A Offerhaus; F J W ten Kate; J G Kusters; E J Kuipers; P D Siersema Journal: Am J Gastroenterol Date: 2011-05-17 Impact factor: 10.864
Authors: E Montgomery; M P Bronner; J R Goldblum; J K Greenson; M M Haber; J Hart; L W Lamps; G Y Lauwers; A J Lazenby; D N Lewin; M E Robert; A Y Toledano; Y Shyr; K Washington Journal: Hum Pathol Date: 2001-04 Impact factor: 3.466
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