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

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.

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