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.
Similar content being viewed by others
References
Altorki NK, Oliveria S, Schrump DS. Epidemiology and molecular biology of Barrett’s adenocarcinoma. Semin Surg Oncol. 1997;13:270–280.
Barrett NR. The lower esophagus lined by columnar epithelium. Surgery. 1957;41:881–894.
Spechler SJ, Goyal RK. The columnar-lined esophagus, intestinal metaplasia, and Norman Barrett. Gastroenterology. 1996;110:614–621.
Blot WJ, Devesa SS, Kneller RW, Fraumeni JF. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA. 1991;265:1287–1289.
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.
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.
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.
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.
Sampliner RE. Effect of up to 3 years of high-dose lansoprazole on Barrett’s esophagus. Am J Gastroenterol. 1994;89:1844–1848.
Yeh RW, Triadafilopoulos G. Endoscopic therapy for Barrett’s esophagus. Gastrointest Endosc Clin N Am. 2005;15:377–397.
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.
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.
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.
Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–2288.
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.
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.
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.
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.
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.
Hirano I, Richter JE. ACG practice guidelines: esophageal reflux testing. Am J Gastroenterol. 2007;102:668–685.
Matthews HR. A proposed classification for hiatal hernia and gastroesophageal reflux. Dis Esophagus. 1996;9:1–3.
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.
Lidums I, Holloway R. Motility abnormalities in the columnar-lined esophagus. Gastroenterol Clin North Am. 1997;26:519–531.
Johnson DA, Winters C, Spurling TJ, Chobanian SJ, Cattau EL. Esophageal acid sensitivity in Barrett’s esophagus. J Clin Gastroenterol. 1987;9:23–27.
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.
Stein HJ, Hoeft S, DeMeester TR. Functional foregut abnormalities in Barrett’s esophagus. J Thorac Cardiovasc Surg. 1993;105:107–111.
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.
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.
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.
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.
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.
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.
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.
O’Connell K, Velanovich V. Effects of Nissen fundoplication on endoscopic endoluminal radiofrequency ablation of Barrett’s esophagus. Surg Endosc. 2011;25:830–834.
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
Corresponding author
Rights 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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-012-2313-2