O'Riordan, J.M.; Byrne, P.J.; Ravi, N.; Keeling, P.W.N.; Reynolds, J.V.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA23
Academic Journal
Background: The appropriate management of Barrett's disease remains controversial. We report the long term outcome of antireflux surgery in Barrett's patients in a tertiary referral centre. Methods: Between 1985 and 2001, 67 patients with Barrett's oesophagus underwent Nissen Fundoplication. Follow up via questionnaire (n = 58), endoscopy/histology (n = 57) and 24 h pH monitoring (n = 41) were examined. Results: At a median follow up of 59 months, 95% (55/58) of patients considered the surgery either excellent/good. The median DeMeester score reduced from 69.5(2-309) before to 6.1(0-222) after surgery (p < 0.001). Lower oesophageal sphincter pressure increased from 7(3-27) mm Hg before to 15(3-40) mm Hg afterwards (p < 0.001). Six patients (10%) had developed recurrent symptoms. 17/41(41%) patients had abnormal post-operative DeMeester scores (> 15) of whom 11 had a reduction in their DeMeester scores but were still outside the normal range. Six out of 8 patients with preoperative dysplasia showed evidence of regression. Dysplasia developed after surgery in 2 patients. Two patients developed adenocarcinoma within Barrett's 4 and 7 years postoperatively, respectively. These 4 patients had abnormal postoperative acid scores. Conclusions: Nissen Fundoplication provides excellent long lasting relief of symptoms in Barrett's patients. Postoperative 24 h pH studies establish that acid reflux has been abolished. Abnormal postoperative studies may be associated with dysplasia and adenocarcinoma in the long term and emphasises the need for long term follow up.


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