Fundoplication provides effective and durable symptom relief in patients with Barrett's esophagus

Timothy M. Farrell, C. Daniel Smith, Ramaz E. Metreveli, Alfred B. Johnson, Kathy D. Galloway, John Hunter

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

BACKGROUND: Columnar-lined esophagus with intestinal metaplasia (IM), also called Barrett's esophagus, is a manifestation of severe gastroesophageal reflux (GER) and may predict poor symptom relief and high failure rate after fundoplication. We compared symptom scores and reoperation rates in GER patients with and without Barrett's esophagus. METHODS: Between July 1992 and July 1997, 646 patients underwent fundoplication (626 laparoscopic). Of 150 endoscopic biopsies of suspected columnar-lined esophagus, 80 confirmed IM, 50 identified cardiac or fundic epithelium, and 20 revealed only esophagitis. Typical GER symptoms were scored by patients preoperatively and postoperatively (0 to 4 scale). We compared symptom response (Wilcoxon rank sum test) and failure rates (t test) in patients with IM and GER controls without IM. Preoperative data were available for 74 IM patients and 496 controls. One-year follow-up was available in 45 IM patients and 301 controls. Intermediate follow-up (2 to 5 years) was available in 20 IM patients and 99 controls. RESULTS: Preoperatively and postoperatively, patients with IM reported heartburn, regurgitation, and dysphagia scores similar to controls. Procedure failure, requiring redo fundoplication, appeared more likely in IM patients than controls (6.3% versus 2.5%), but this difference did not reach statistical significance (P = 0.061). CONCLUSION: Fundoplication provides equivalent symptom relief for patients with and without IM.

Original languageEnglish (US)
Pages (from-to)18-21
Number of pages4
JournalAmerican Journal of Surgery
Volume178
Issue number1
DOIs
StatePublished - Jul 1999
Externally publishedYes

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Fundoplication
Barrett Esophagus
Metaplasia
Gastroesophageal Reflux
Nonparametric Statistics
Esophagus
Heartburn
Esophagitis
Deglutition Disorders
Reoperation
Epithelium
Biopsy

ASJC Scopus subject areas

  • Surgery

Cite this

Fundoplication provides effective and durable symptom relief in patients with Barrett's esophagus. / Farrell, Timothy M.; Smith, C. Daniel; Metreveli, Ramaz E.; Johnson, Alfred B.; Galloway, Kathy D.; Hunter, John.

In: American Journal of Surgery, Vol. 178, No. 1, 07.1999, p. 18-21.

Research output: Contribution to journalArticle

Farrell, Timothy M. ; Smith, C. Daniel ; Metreveli, Ramaz E. ; Johnson, Alfred B. ; Galloway, Kathy D. ; Hunter, John. / Fundoplication provides effective and durable symptom relief in patients with Barrett's esophagus. In: American Journal of Surgery. 1999 ; Vol. 178, No. 1. pp. 18-21.
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