2005 Abstracts: Progression of Barrett-Esophagus Under Antireflux-Therapy
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Progression of Barrett-Esophagus Under Antireflux-Therapy
Karl H. Fuchs, Markus-Hospital, Frankfurt, Germany, Germany; Martin Fein, Joern Maroske, University Hospital Wuerzburg, Wuerzburg, Germany, Germany; Wolfram Breithaupt, Isolde Hammer, Markus-Hospital, Frankfurt, Germany, Germany
Introduction: Intestinal Metaplasia (IM) in specialized columnar lined epithelium in the distalesophagusis a precancerous lesion with a cancer risk of0,5 % or 1 case in 200 patient-years. There are no prospective multicenter-data available for Germany regarding the cancer-risk and also no data regarding different therapeutic treatment-options. The purpose of this study is the evaluation of Barrett`s esophagus(BE)progression in patients underantireflux therapy either laparoscopic fundoplication(LF) or PPI-treatment, based on the data of the german Barrett registry.
Methods: In a Consensusprocess a protocol was established byPathologists (n=3), Gastroenterologists (n=22) and Surgeons (n=9), in whichprospectively and multicentric collected data of the natural and posttherapeutic course of patients with IM were registered regardinghistory, endoscopy, histopathology and functional diagnostics. Barrett`s esophagus was defined as specialized, intestinal metaplasie in the endoscopic visiblecolumnar lined epithelium in the esophagus independent of its length. Patients gave their informed consent for a central data registration. Participating centers were free to decide for their own treatment option for each patient regardingIM as well as the underlying reflux disease. Results: SinceJanuary 2000555 patients with BE were prospectively registered and analysed. 14 centers participated ( 3 surgicaln=397; 11 gastroenterologicn=158). Refluxsymptoms were present in56 % of patients daily or weekly, in 25 % they were absent. The mean age was 57 years(10-89); (male: 396;female: 159); short-segment-BE: 63%; long-segment-BE: 37%; Initially 35 patients were documented with intraepithelial neoplasia (24 Low grade intraepithelial neoplasia LGIEN; 5 HGIEN; 6 indefinite). In the second histologic confirmation 3 HGIEN, 9 LGIEN und 2 indefinite histologies were confirmed. In the other patientsIEN was excluded. From all patients 2(1 insufficient and 1 compentent LF) have shownprogressionfrom IM to LGIEN and one from IM to cancer (PPI)in a total of1560 documented patient-years. Conclusion: The current analysis shows for PPI treatment as well as for laparoscopic antireflux-surgery a low rate of progression. This confirms recent reports on Barrett`s esophagus, that progression is a rather infrequent problem, which can not be prevented by antireflux surgery nor by PPI.
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