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

Autor:	Baldaque-Silva F; Francisco Baldaque-Silva, Institute of Medicine, Karolinska Institutet, Karolinska University Hospital, 14186 Stockholm, Sweden., Vieth M; Francisco Baldaque-Silva, Institute of Medicine, Karolinska Institutet, Karolinska University Hospital, 14186 Stockholm, Sweden., Debel M; Francisco Baldaque-Silva, Institute of Medicine, Karolinska Institutet, Karolinska University Hospital, 14186 Stockholm, Sweden., Håkanson B; Francisco Baldaque-Silva, Institute of Medicine, Karolinska Institutet, Karolinska University Hospital, 14186 Stockholm, Sweden., Thorell A; Francisco Baldaque-Silva, Institute of Medicine, Karolinska Institutet, Karolinska University Hospital, 14186 Stockholm, Sweden., Lunet N; Francisco Baldaque-Silva, Institute of Medicine, Karolinska Institutet, Karolinska University Hospital, 14186 Stockholm, Sweden., Song H; Francisco Baldaque-Silva, Institute of Medicine, Karolinska Institutet, Karolinska University Hospital, 14186 Stockholm, Sweden., Mascarenhas-Saraiva M; Francisco Baldaque-Silva, Institute of Medicine, Karolinska Institutet, Karolinska University Hospital, 14186 Stockholm, Sweden., Pereira G; Francisco Baldaque-Silva, Institute of Medicine, Karolinska Institutet, Karolinska University Hospital, 14186 Stockholm, Sweden., Lundell L; Francisco Baldaque-Silva, Institute of Medicine, Karolinska Institutet, Karolinska University Hospital, 14186 Stockholm, Sweden., Marschall HU; Francisco Baldaque-Silva, Institute of Medicine, Karolinska Institutet, Karolinska University Hospital, 14186 Stockholm, Sweden.
Jazyk:	angličtina
Zdroj:	World journal of gastroenterology [World J Gastroenterol] 2017 May 07; Vol. 23 (17), pp. 3174-3183.
DOI:	10.3748/wjg.v23.i17.3174
Abstrakt:	Aim: To determine the impact of upwards titration of proton pump inhibition (PPI) on acid reflux, symptom scores and histology, compared to clinically successful fundoplication. Methods: 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 pH 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. Competing Interests: Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Databáze:	MEDLINE
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