Barrett's esophagus can develop after antireflux surgery

Abstract

BACKGROUND: Surgical treatment in patients with gastroesophageal reflux disease (GERD) without Barrett's esophagus (BE) is an excellent alternative therapy to medical treatment, preventing the development of complications and the appearance of BE. PURPOSE: To determine the newly developed BE in a group of patients without BE prior to surgery, the patients were submitted to a late subjective and objective follow-up. METHODS: From 115 non-BE patients submitted to surgery and followed up for a long period, 12 (10.4%) developed intestinal metaplasia after operation. They were submitted to endoscopic, histologic, manometric and functional studies (24-h pH and Bilitec). RESULTS: The 12 patients had an average of 5 endoscopies after surgery with several biopsy samples. Symptoms of recurrent reflux were present in only 10 patients (83%) at a mean of 80 months after surgery. The mean follow-up was 135 months. Four patients showed the absence of pathologic reflux measured by 24-h pH and Bilitec monitoring, while 8 had the presence of abnormal acid reflux. There were no significant differences between endoscopic, histologic and functional studies comparing patients with the presence or absence of pathologic reflux. The time of appearance to intestinal metaplasia from cardiac or oxynto-Cardiac mucosa was 58-90 months. Four patients showed regression of intestinal metaplasia to cardiac mucosa after intensive medical treatment. CONCLUSIONS: Antireflux surgery in patients without BE does not prevent the late appearance of BE in near 10% of the cases, provided that a long-term follow-up is performed and several endoscopic and histologic evaluations are repeated. Near 2/3 of these patients showed the presence of acid reflux, while 1/3 showed no abnormal reflux. With this method of follow-up, metaplastic changes from cardiac to intestinal metaplasia and from intestinal metaplasia to low-grade dysplasia can be documented, as well as regression from intestinal metaplasia to cardiac mucosa.