In this study, researchers from Los Angeles, California, investigated factors leading to histologic regression of metaplastic and dysplastic Barrett's esophagus (BE).
They studied 91 consecutive patients with symptomatic Barrett's esophagus.
The team reviewed pre- and post-treatment endoscopic biopsies from 77 patients treated surgically and 14 treated with proton pump inhibitors (PPI).
An expert pathologist confirmed the presence of intestinal metaplasia (IM), with or without dysplasia.
| Presence of short segment Barrett's esophagus was significantly associated with regression.|
|Journal of the American College of Surgeons|
The researchers classified post-treatment histology as regressed if 2 consecutive biopsies, taken more than 6 months apart plus all subsequent biopsies, showed loss of IM or loss of dysplasia.
They assessed clinical factors associated with regression using multivariate analysis.
The research team found that histopathologic regression occurred in 36% patients after antireflux surgery, and in 7% of patients treated with PPIs alone.
Following surgery, regression from low-grade dysplastic to nondysplastic BE occurred in 68% of patients. Regression from IM to no IM occurred in 21%.
The team found that both types of regression were more common in short (<3 cm) than long (> 3 cm) segment Barrett's esophagus (58% versus 20%, respectively).
However, 8 patients progressed. Of these, 5 progressed from IM alone to low-grade dysplasia, and 3 from low- to high-grade dysplasia.
The researchers determined that all those who progressed had long segment BE.
Multivariate analysis showed that the presence of short segment Barrett's and type of treatment were significantly associated with regression.
However, age, gender, surgical procedure, and preoperative lower esophageal sphincter, and pH characteristics were not.
The team determined that the median time of biopsy-proved regression was 18.5 months after surgery, with 95% occurring within 5 years.
Dr Richard Gurski’s team concluded, “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 follow up after antireflux surgery”.