Impact of gastroesophageal reflux control through tailored proton pump inhibition therapy or fundoplication in patients with Barrett's esophagus

作     者：Francisco Baldaque-Silva Michael Vieth Mumen Debel Bengt Hakanson Anders Thorell Nuno Lunet Huan Song Miguel Mascarenhas-Saraiva Gisela Pereira Lars Lundell Hanns-Ulrich Marschall 

作者机构：Institute of MedicineKarolinska InstitutetKarolinska University Hospital Department of PathologyKlinikum Bayreuth Department of SurgeryErsta Hospital Department of Clinical SciencesDanderydKarolinska Institutet Department of Clinical EpidemiologyPredictive Medicine and Public HealthUniversity of Porto Medical School Department of Medical Epidemiology and BiostatisticsKarolinska Institutet Department of GastroenterologyManop H and Instituto CUF ClintecKarolinska InstitutetKarolinska University Hospital Department of Molecular and Clinical MedicineSahlgrenska AcademyUniversity of Gothenburg 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2017年第23卷第17期

页      面：3174-3183页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Barrett’s esophagus Acid reflux Proton pump inhibitors Health related quality of life Gastroesophageal reflux Symptom control Antireflux surgery 

摘      要：AIM To determine the impact of upwards titration of proton pump inhibition(PPI) on acid reflux, symptom scores and histology, compared to clinically successful *** Two cohorts of long-segment Barrett s esophagus(BE) patients were studied. In group 1(n = 24), increasing doses of PPI were administered in 8-wk intervals until acid reflux normalization. At each assessment, ambulatory 24 h p H recording, endoscopy with biopsies and symptom scoring(by a gastroesophageal reflux disease health related quality of life questionnaire, GERD/HRLQ) were performed. Group 2(n = 30) consisted of patients with a previous fundoplication. RESULTS In group 1, acid reflux normalized in 23 of 24 patients, resulting in improved GERD/HRQL scores(P = 0.001), which were most pronounced after the starting dose of PPI(P 0.001). PPI treatment reached the same level of GERD/HRQL scores as after a clinically successful fundoplication(P = 0.5). Normalization of acid reflux in both groups was associated with reduction in papillary length, basal cell layer thickness, intercellular space dilatation, and acute and chronic inflammation of squamous epithelium. CONCLUSION This study shows that acid reflux and symptom scores co-vary throughout PPI increments in long-segment BE patients, especially after the first dose of PPI, reaching the same level as after a successful fundoplication. Minor changes were found among GERD markers at the morphological level.