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Neoplastic progression in short‐segment Barrett's oesophagus is associated with impairment of chemical clearance, but not inadequate acid suppression by proton pump inhibitor therapy
Author(s) -
Frazzoni M.,
Bertani H.,
Conigliaro R.,
Frazzoni L.,
Losi L.,
Melotti G.
Publication year - 2014
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12895
Subject(s) - medicine , dysplasia , gastroenterology , heartburn , reflux , esophageal disease , population , endoscopy , surgery , esophagus , disease , environmental health
Summary Background Pathophysiological mechanisms associated with neoplastic progression in patients with short‐segment Barrett's oesophagus ( SSBO ), who represent the vast majority of the Barrett population, have not been defined. Aim To evaluate pathophysiological characteristics of patients with SSBO and dysplasia detected at 3‐year surveillance endoscopy (incident dysplasia). Methods Patients with SSBO underwent impedance‐ pH monitoring during heartburn‐suppressing PPI therapy. Fifteen patients (12 males, median age 62 years) with incident dysplasia and 50 patients (43 males, median age 59 years) without dysplasia were compared. Impedance‐ pH parameters, including chemical clearance assessed by the post‐reflux swallow‐induced peristaltic wave (PSPW) index, were evaluated. Results All patients declared persisting heartburn suppression on maintenance PPI therapy at 3‐year follow‐up, 58/65 (89%) with standard dosages. The median gastric and oesophageal acid exposure time ( GAET and OAET ) did not differ between patients with and without incident dysplasia at the time of surveillance (36% and 0.6% vs. 33% and 0.5%) or index endoscopy (33% and 0.3% vs. 41% and 0.5%) ( P > 0.05). Contrastingly, the median PSPW index was significantly lower in patients with than in patients without incident dysplasia at the time of surveillance (15%, vs. 32%) and index endoscopy (12% vs. 30%) ( P = 0.001). The PSPW index, the GAET and the OAET did not vary over time ( P > 0.05). A PSPW index <26% was predictive of incident dysplasia with a 75% accuracy. Conclusions Neoplastic progression in SSBO is associated with impairment of chemical clearance, but not inadequate acid suppression by PPI therapy. Neoplastic progression in SSBO can be predicted by a low PSPW index.