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Surgical management of GERD patients with Barrett’s esophagus

The latest issue of the Journal of Gastrointestinal Surgery examines medical or surgical management of GERD patients with Barrett’s esophagus.

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The long-term management of gastroesophageal reflux in patients with Barrett’s esophagus is not well supported by an evidence-based consensus.

Dr Attwood and colleagues from the United Kingdom compared treatment outcomes in patients with and without Barrett’s esophagus submitted to standardized laparoscopic antireflux surgery or esomeprazole treatment.

13% of Barrett’s patients on either treatment strategy experienced treatment failure
Journal of Gastrointestinal Surgery

The team compared the long-term usage of acid suppression versus antireflux surgery trial.

The research team evaluated laparoscopic antireflux surgery with dose-adjusted esomeprazole, operative difficulty, and complications.

The team reported symptom outcomes using the Gastrointestinal Symptom Rating Scale and Quality of Life in Reflux and Dyspepsia, and treatment failure at 3 years as well as pH testing.

The researchers found that of 554 patients with gastroesophageal reflux disease (GERD), 60 had Barrett’s esophagus.

Of the 60 patients with Barrett’s, 28 were randomized to esomeprazole, and 32 to laparoscopic antireflux surgery.

The team noted that 13% of Barrett’s esophagus patients on either treatment strategy experienced treatment failure during the 3-year follow-up.

Esophageal pH in Barrett’s esophagus patients was significantly better controlled after surgical treatment than after esomeprazole.

Although mean Gastrointestinal Symptom Rating Scale and Quality of Life in Reflux and Dyspepsia scores were similar for the 2 therapies at baseline and at 3 years.

Although operative difficulty was slightly greater in patients with Barrett’s esophagus than those without, the research team noted no difference in postoperative complications or level of symptomatic reflux control.

Dr Attwood’s team concluded, “ In a well-controlled surgical environment, the success of laparoscopic antireflux surgery is similar in patients with or without Barrett’s esophagus and matches optimized medical therapy.”

J Gastrointest Surg 2008: 12(10): 1646-55


29 September 2008

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