Barrett's esophagus: What do we need to know?

Background: Gastroesophageal reflux disease (GERD) has a high prevalence worldwide and plays a major role in the development of Barrett's esophagus (BЕ) and esophageal adenocarcinoma. Aims: To evaluate the patterns of esophageal acidification and esophageal motility in patients with BЕ in comparison with various GERD phenotypes and control subjects. Materials and methods: 100 patients were examined: 31 patients with nonerosive reflux disease (NERD), 20 patients with erosive reflux disease (ERD), 17 patients with BE, 32 healthy individuals who made up the control group. All patients underwent 24-hours pH-impedance and high-resolution esophageal manometry. Results: According to the 24-hour pH-impedanсe, the total time with pH 4 in the esophagus was 1,9% in control patients, 11.6% in the NERD group, 19.35 in the ERD group and 28% in patients with BE. The average number of acid refluxes was 18.0 in the control group, 58.0 in the group with NERD, 78. in the group with ERD and 89.0 in patients with BE. The number of acidic refluxes was significantly correlated with the time on the acidification of the esophagus (r = 0.5439; p0.05). The analysis of the mean nocturnal baseline impedance (MNBI) revealed a tendency to decrease the values in patients with GERD relative to the control subjects, and there was a decrease in the values of MNBI as the severity of GERD from NERD to ERD and BE (p0.05). Manometric signs of hiatal hernia and/or hypotension of the lower esophageal sphincter were more often registered in the groups of patients with ERD (70%) and BE (65%) than in patients with NERD (32%) and in control group (12%). Conclusions: Increase in level of total time with pH 4, number of acid refluxes, reduced values of MNBI, as well as disorders of the structure and function of the esophagogastric junction and motility of the esophagus are associated with the severity of esophagus diseases.

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Section: обоснованиеunclassified

Patterns of esophageal acidification and impairment of esophageal motility in gastroesophageal reflux disease and Barrett's esophagus

et al. 2020

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“…При ПБ нормальный неороговевающий многослойный плоский эпителий дистального отдела пищевода замещается специализированным цилиндрическим эпителием с бокаловидными клетками [1][2][3]. Частота выявления ПБ, по данным ряда публикаций, достигает 4 % [4]. При этом у пациентов с данной патологией риск развития аденокарциномы пищевода (АКП) в 30-125 раз выше, чем в общей популяции [5].…”

Section: Introductionunclassified

Asymptomatic Barrett’s Oesophagus-Complicated Gastroesophageal Reflux Disease at Ineffective Antisecretory Therapy

Barkalova

Пирогов

Andreev

et al. 2021

Rossijskij žurnal gastroènterologii, gepatologii, koloproktolog

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Aim. A clinical description of gastroesophageal reflux disease (GERD) complicated by Barrett’s oesophagus (BO) at inadequate antisecretory therapy and the assessment of functional tests in control of conservative treatment.Key points. A 63-yo patient with no complaints in a proton pump inhibitor (PPI) therapy was admitted for a follow-up examination for BO-complicated GERD using oesophagogastroduodenoscopy (OGDS) with biopsy, high-resolution oesophageal manometry and 24-h pH-impedance. Endoscopy revealed signs of BO (long segment C1M3), erosive reflux oesophagitis (grade B in Los Angeles classification). Non-contractile oesophagus in manometry. Antisecretory therapy was stated ineffective and subject to correction in 24-h pH-impedance.Conclusion. Asymptomatic BO-complicated GERD patients comprise a special cohort. The main challenge to prevent progression into oesophageal adenocarcinoma is an adequate personalised patient management leveraging the modern diagnostic techniques, control of antisecretory treatment and its correction a situ.

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“…), обобщившему результаты 44 исследований, частота гистологически верифицированного ПБ у пациентов с ГЭРБ составляет 7,2% (95% ДИ 5,4-9,3%), тогда как эндоскопические признаки ПБ выявляются у 12,0% больных (95% ДИ 5,5-20,3%) [6]. Доказанными факторами риска ПБ являются европеоидная раса, мужской пол, табакокурение, абдоминальное ожирение [7][8][9][10]. Клинико-социальная значимость ПБ определяется риском развития аденокарциномы пищевода, характеризующейся крайне неблагоприятным прогнозом и высокой летальностью [11].…”

Section: Introductionunclassified

Efficacy of esophagoprotection with short periods of withdrawal of maintenance therapy with proton pump inhibitors in patients with Barrett's esophagus

Kucheryavy¹,

Movtaeva²,

Zayratyants³

et al. 2021

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Aim. Evaluation of the effectiveness of esophagoprotection in covering up short periods of withdrawal of maintenance therapy with proton pump inhibitors (PPIs) in patients with Barrett's esophagus (BE). Materials and methods. A retrospective analysis of the data of patients with histologically verified BE who received outpatient PPI therapy for at least 12 months was carried out. This cohort was divided into two groups to compare depending on the treatment regimen received. The first group included only patients who take PPIs constantly, while the second group included patients who had periodic interruptions in taking PPIs. In the second group, we analyzed only cases where to cover up the periods of PPI withdrawal the patients used the esophagoprotector Alfasoxx (10 ml 4 times a day, after each meal and at night). In the cohort, demographic data (age, gender), risk factors, length of the BE segment, degree of dysplasia, number of relapses of erosive esophagitis, and the data of high-resolution manometry on movement disorders of the thoracic esophagus (ineffective motility and lack of contractility) were analyzed. Results. The study included 39 patients (28 men and 11 women) with histologically verified BE. The average age was 57,1538 years (95% confidence interval 53.4269–60.8808). The gender structure was dominated by men (n=28). The duration of BE history in the analyzed cohort was 5.6769 years (95% confidence interval, 4.6161–6.7378). The first group consisted of 23 patients who take PPIs constantly. The second group consisted of 16 patients who had periodic interruptions in taking PPIs, which were covered by the esophagoprotector Alfasoxx. In the analyzed cohort, there were no significant differences between the groups in the average length of the BE segment, the number of patients with a long BE segment, the degree of dysplasia, the number of relapses of erosive esophagitis, and the rate of movement disorders of the thoracic esophagus. Conclusion. In routine practice, there are reasons for the temporary withdrawal of PPIs in patients with BE, which requires the administration of course esophagoprotection to cover up the risks. The results of this retrospective comparative study demonstrate the effectiveness of this strategy.

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Barrett's esophagus: What do we need to know?

Cited by 17 publications

References 74 publications

Patterns of esophageal acidification and impairment of esophageal motility in gastroesophageal reflux disease and Barrett's esophagus

Patterns of esophageal acidification and impairment of esophageal motility in gastroesophageal reflux disease and Barrett's esophagus

Asymptomatic Barrett’s Oesophagus-Complicated Gastroesophageal Reflux Disease at Ineffective Antisecretory Therapy

Efficacy of esophagoprotection with short periods of withdrawal of maintenance therapy with proton pump inhibitors in patients with Barrett's esophagus

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