Barrett's esophagus can and does regress after antireflux surgery

A study of prevalence and predictive features

Richard R. Gurski, Jeffrey H. Peters, Jeffrey A. Hagen, Steven R. DeMeester, Cedric G. Bremner, Parakrama T. Chandrasoma, Tom R. DeMeester, John Hunter

Research output: Contribution to journalArticle

115 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)706-713
Number of pages8
JournalJournal of the American College of Surgeons
Volume196
Issue number5
DOIs
StatePublished - May 1 2003
Externally publishedYes

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Barrett Esophagus
Cross-Sectional Studies
Metaplasia
Biopsy
Multivariate Analysis
Preoperative Care
Lower Esophageal Sphincter
Proton Pump Inhibitors
Esophagus
Histology

ASJC Scopus subject areas

  • Surgery

Cite this

Barrett's esophagus can and does regress after antireflux surgery : A study of prevalence and predictive features. / Gurski, Richard R.; Peters, Jeffrey H.; Hagen, Jeffrey A.; DeMeester, Steven R.; Bremner, Cedric G.; Chandrasoma, Parakrama T.; DeMeester, Tom R.; Hunter, John.

In: Journal of the American College of Surgeons, Vol. 196, No. 5, 01.05.2003, p. 706-713.

Research output: Contribution to journalArticle

Gurski, Richard R. ; Peters, Jeffrey H. ; Hagen, Jeffrey A. ; DeMeester, Steven R. ; Bremner, Cedric G. ; Chandrasoma, Parakrama T. ; DeMeester, Tom R. ; Hunter, John. / Barrett's esophagus can and does regress after antireflux surgery : A study of prevalence and predictive features. In: Journal of the American College of Surgeons. 2003 ; Vol. 196, No. 5. pp. 706-713.
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abstract = "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.",
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AU - Peters, Jeffrey H.

AU - Hagen, Jeffrey A.

AU - DeMeester, Steven R.

AU - Bremner, Cedric G.

AU - Chandrasoma, Parakrama T.

AU - DeMeester, Tom R.

AU - Hunter, John

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N2 - 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.

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