Skip to main content

Advertisement

Log in

Effective Intra-Esophageal Acid Control Is Associated with Improved Radiofrequency Ablation Outcomes in Barrett’s Esophagus

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Endoscopic radiofrequency ablation (RFA) is a promising new treatment of Barrett’s esophagus (BE). Adjunctive intra-esophageal pH control with proton pump inhibitors and/or anti-reflux surgery is generally recommended to optimize squamous re-epithelialization after ablation.

Aims

The aims of this study were to examine the association between intra-esophageal pH control and RFA outcomes and to identify predictive factors to achieve complete elimination (CE) of BE following RFA.

Methods

We retrospectively studied the outcomes of BE patients treated with RFA. Esophageal acid exposure (EAE) was assessed utilizing 24-h pH monitoring on therapy. CE was endoscopically defined as no area suspicious for residual metaplasia following RFA.

Results

Of 45 patients (33 men; mean age 61.6, mean BE length C4.1 M4.6) examined for EAE, 29 % exhibited moderate–severe EAE despite therapy. Reduction in BE surface area and CE rate were higher in the normal-mild EAE group compared with the moderate–severe EAE group (99 vs. 95 %, p = 0.02; 44 vs. 15 %, p = 0.09, respectively). Using univariate analysis, age, gender, race, aspirin/NSAIDs use, baseline worst histology, baseline BE surface area, and the number or types of RFA had no correlation with CE. By multivariate multiple logistic regression analysis, normal-mild EAE and smaller hiatal hernia were independent factors associated with CE.

Conclusions

Effective intra-esophageal pH control is associated with improved RFA outcomes of BE. Normal to mild EAE and smaller hiatal hernia are predictive factors to achieve CE. Given the frequent persistence of acid reflux despite therapy in BE patients, in order to maximize the RFA effects esophageal pH optimization and hernia repair should be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Altorki NK, Oliveria S, Schrump DS. Epidemiology and molecular biology of Barrett’s adenocarcinoma. Semin Surg Oncol. 1997;13:270–280.

    Article  PubMed  CAS  Google Scholar 

  2. Barrett NR. The lower esophagus lined by columnar epithelium. Surgery. 1957;41:881–894.

    PubMed  CAS  Google Scholar 

  3. Spechler SJ, Goyal RK. The columnar-lined esophagus, intestinal metaplasia, and Norman Barrett. Gastroenterology. 1996;110:614–621.

    Article  PubMed  CAS  Google Scholar 

  4. Blot WJ, Devesa SS, Kneller RW, Fraumeni JF. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA. 1991;265:1287–1289.

    Article  PubMed  CAS  Google Scholar 

  5. Eloubeidi MA, Mason AC, Desmond RA, El-Serag HB. Temporal trends (1973–1997) in survival of patients with esophageal adenocarcinoma in the United States: a glimmer of hope? Am J Gastroenterol. 2003;98:1627–1633.

    PubMed  Google Scholar 

  6. Ouatu-Lascar R, Fitzgerald RC, Triadafilopoulos G. Differentiation and proliferation in Barrett’s esophagus and the effects of acid suppression. Gastroenterology. 1999;117:327–335.

    Article  PubMed  CAS  Google Scholar 

  7. Cooper BT, Chapman W, Neumann CS, Gearty JC. Continuous treatment of Barrett’s oesophagus patients with proton pump inhibitors up to 13 years: observations on regression and cancer incidence. Aliment Pharmacol Ther. 2006;23:727–733.

    Article  PubMed  CAS  Google Scholar 

  8. Peters FT, Ganesh S, Kuipers EJ, et al. Endoscopic regression of Barrett’s oesophagus during omeprazole treatment; a randomised double blind study. Gut. 1999;45:489–494.

    Article  PubMed  CAS  Google Scholar 

  9. Sampliner RE. Effect of up to 3 years of high-dose lansoprazole on Barrett’s esophagus. Am J Gastroenterol. 1994;89:1844–1848.

    PubMed  CAS  Google Scholar 

  10. Yeh RW, Triadafilopoulos G. Endoscopic therapy for Barrett’s esophagus. Gastrointest Endosc Clin N Am. 2005;15:377–397.

    Article  PubMed  Google Scholar 

  11. Fleischer D, Overholt B, Sharma V, et al. Endoscopic ablation of Barrett’s esophagus: a multicenter study with 2.5-year follow-up. Gastrointest Endosc. 2008;68:867–876.

    Article  PubMed  Google Scholar 

  12. Ganz R, Overholt B, Sharma V, et al. Circumferential ablation of Barrett’s esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry. Gastrointest Endosc. 2008;68:35–40.

    Article  PubMed  Google Scholar 

  13. Pouw R, Wirths K, Eisendrath P, et al. Efficacy of radiofrequency ablation combined with endoscopic resection for Barrett’s esophagus with early neoplasia. Clin Gastroenterol Hepatol. 2010;8:23–29.

    Article  PubMed  Google Scholar 

  14. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–2288.

    Article  PubMed  CAS  Google Scholar 

  15. Sharma V, Jae Kim H, Das A, Wells C, Nguyen C, Fleischer D. Circumferential and focal ablation of Barrett’s esophagus containing dysplasia. Am J Gastroenterol. 2009;104:310–317.

    Article  PubMed  Google Scholar 

  16. Gerson LB, Boparai V, Ullah N, Triadafilopoulos G. Oesophageal and gastric pH profiles in patients with gastro-oesophageal reflux disease and Barrett’s oesophagus treated with proton pump inhibitors. Aliment Pharmacol Ther. 2004;20:637–643.

    Article  PubMed  CAS  Google Scholar 

  17. Ouatu-Lascar R, Triadafilopoulos G. Complete elimination of reflux symptoms does not guarantee normalization of intraesophageal acid reflux in patients with Barrett’s esophagus. Am J Gastroenterol. 1998;93:711–716.

    Article  PubMed  CAS  Google Scholar 

  18. Gerson LB, Edson R, Lavori PW, Triadafilopoulos G. Use of a simple symptom questionnaire to predict Barrett’s esophagus in patients with symptoms of gastroesophageal reflux. Am J Gastroenterol. 2001;96:2005–2012.

    Article  PubMed  CAS  Google Scholar 

  19. Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology. 2006;131:1392–1399.

    Article  PubMed  Google Scholar 

  20. Hirano I, Richter JE. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102:668–685.

    Article  PubMed  Google Scholar 

  21. Matthews HR. A proposed classification for hiatal hernia and gastroesophageal reflux. Dis Esophagus. 1996;9:1–3.

    Google Scholar 

  22. Yeh RW, Gerson LB, Triadafilopoulos G. Efficacy of esomeprazole in controlling reflux symptoms, intraesophageal, and intragastric pH in patients with Barrett’s esophagus. Dis Esophagus. 2003;16:193–198.

    Article  PubMed  CAS  Google Scholar 

  23. Lidums I, Holloway R. Motility abnormalities in the columnar-lined esophagus. Gastroenterol Clin North Am. 1997;26:519–531.

    Article  PubMed  CAS  Google Scholar 

  24. Johnson DA, Winters C, Spurling TJ, Chobanian SJ, Cattau EL. Esophageal acid sensitivity in Barrett’s esophagus. J Clin Gastroenterol. 1987;9:23–27.

    Article  PubMed  CAS  Google Scholar 

  25. Trimble KC, Pryde A, Heading RC. Lowered oesophageal sensory thresholds in patients with symptomatic but not excess gastro-oesophageal reflux: evidence for a spectrum of visceral sensitivity in GORD. Gut. 1995;37:7–12.

    Article  PubMed  CAS  Google Scholar 

  26. Stein HJ, Hoeft S, DeMeester TR. Functional foregut abnormalities in Barrett’s esophagus. J Thorac Cardiovasc Surg. 1993;105:107–111.

    PubMed  CAS  Google Scholar 

  27. Roorda AK, Marcus SN, Triadafilopoulos G. Early experience with radiofrequency energy ablation therapy for Barrett’s esophagus with and without dysplasia. Dis Esophagus. 2007;20:516–522.

    Article  PubMed  CAS  Google Scholar 

  28. Basu KK, Pick B, Bale R, West KP, de Caestecker JS. Efficacy and one year follow up of argon plasma coagulation therapy for ablation of Barrett’s oesophagus: factors determining persistence and recurrence of Barrett’s epithelium. Gut. 2002;51:776–780.

    Article  PubMed  CAS  Google Scholar 

  29. Kahaleh M, Van Laethem J-L, Nagy N, Cremer M, Devière J. Long-term follow-up and factors predictive of recurrence in Barrett’s esophagus treated by argon plasma coagulation and acid suppression. Endoscopy. 2002;34:950–955.

    Article  PubMed  CAS  Google Scholar 

  30. Ferraris R, Fracchia M, Foti M, et al. Barrett’s oesophagus: long-term follow-up after complete ablation with argon plasma coagulation and the factors that determine its recurrence. Aliment Pharmacol Ther. 2007;25:835–840.

    Article  PubMed  CAS  Google Scholar 

  31. Sampliner RE, Fennerty B, Garewal HS. Reversal of Barrett’s esophagus with acid suppression and multipolar electrocoagulation: preliminary results. Gastrointest Endosc. 1996;44:532–535.

    Article  PubMed  CAS  Google Scholar 

  32. Sampliner RE, Camargo L, Fass R. Impact of esophageal acid exposure on the endoscopic reversal of Barrett’s esophagus. Am J Gastroenterol. 2002;97:270–272.

    Article  PubMed  Google Scholar 

  33. Kovacs BJ, Chen YK, Lewis TD, DeGuzman LJ, Thompson KS. Successful reversal of Barrett’s esophagus with multipolar electrocoagulation despite inadequate acid suppression. Gastrointest Endosc. 1999;49:547–553.

    Article  PubMed  CAS  Google Scholar 

  34. O’Connell K, Velanovich V. Effects of Nissen fundoplication on endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus. Surg Endosc. 2011;25:830–834.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Jennifer Vassalle for her invaluable assistance in data collection for this study.

Conflict of interest

GT has received consulting honoraria from BÂRRX Medical, Inc.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to George Triadafilopoulos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Akiyama, J., Marcus, S.N. & Triadafilopoulos, G. Effective Intra-Esophageal Acid Control Is Associated with Improved Radiofrequency Ablation Outcomes in Barrett’s Esophagus. Dig Dis Sci 57, 2625–2632 (2012). https://doi.org/10.1007/s10620-012-2313-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-012-2313-2

Keywords

Navigation