Risk for persistent intestinal metaplasia in Barrett's

This month's issue of Gastroenterology reports an increased risk for persistent intestinal metaplasia in patients with Barrett's esophagus and uncontrolled reflux exposure before radiofrequency ablation.

Radiofrequency ablation is a safe alternative to esophagectomy for patients with dysplastic Barrett's esophagus.

Although some studies have indicated that radiofrequency ablation is effective at eradicating dysplasia, most have found that radiofrequency ablation is not as effective in eradicating intestinal metaplasia.

Dr Srinadh Komanduri and colleagues from Chicago, Illinois investigated whether uncontrolled reflux is associated with persistent intestinal metaplasia after radiofrequency ablation.

The research team identified 37 patients with Barrett's esophagus who underwent radiofrequency ablation, high-resolution manometry, and 24-hour impedance-pH testing.

The patients received proton pump inhibitors twice daily.

Complete responders had fewer weakly acidic events

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Patients returned every 2 months for repeat treatment or standard surveillance.

Patients were classified as complete responders if all intestinal metaplasia was eradicated in fewer than 3 ablation sessions.

The researchers analyzed clinical parameters to identify factors associated with a complete responders or incomplete responder.

Among the 37 patients, 22 had a complete responder, and 15 had an incomplete responder. 

The researchers showed that length of Barrett's esophagus, size of hiatal hernia, and frequency of reflux, but not acid reflux, differed between complete responders and incomplete responders.

Complete responders had fewer weakly acidic events than incomplete responders, and total reflux events, and a trend toward fewer weakly alkaline events.

The research team noted that no other clinical or manometric features differed between groups.

Dr Komanduri's team concludes, "Uncontrolled, predominantly weakly acidic reflux despite twice-daily proton pump inhibitor therapy before radiofrequency ablation increases the incidence of persistent intestinal metaplasia after ablation in patients with Barrett's esophagus."

"Length of Barrett's esophagus and size of hiatal hernia also were associated with persistent intestinal metaplasia after radiofrequency ablation."