Gastroesophageal Reflux Disease and Barrett's Esophagus

Abstract

There was enormous interest in the diagnosis and treatment of gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE) at this year's Digestive Diseases Week (DDW). Since this topic predominated over other areas of clinical research in gastrointestinal endoscopy, it will be given broader scope in this series of DDW reports. As usual in recent years, data have been taken from the published abstracts, to avoid confusion; exceptions are only made for some of the new endoscopic antireflux treatments. Gastroesophageal Reflux Disease Diagnostic AspectsThree abstracts dealt with the appearance of GERD after Helicobacter pylori eradication therapy. In a large study in 168 peptic ulcer patients in Korea, with careful followup at one, six, 12, and 24 months, no difference was found in the development of reflux esophagitis between patients with successful eradication (n = 12) and those in whom eradication failed (n = 43) -3.2 % versus 4.7 % [1]. In a much smaller study in Greece, 24 % of 50 patients developed reflux esophagitis, 75 % of those during the first year; a control group was not included in this study [2]. In another study examining 52 patients with known GERD after H. pylori eradication, both the subjective and objective reflux parameters worsened, but the percentages were not quite clear from the entire group [3]. No conclusive evidence was therefore presented to solve this question in this year's DDW abstracts; regional differences may possibly play a role.Intraobserver and interobserver variability in the grading of reflux esophagitis using two different scales was good (with kappa values between 0.39 and 0.56) when both experts and trainees examined 325 photographs [4]. Histolo-gy did not contribute significantly to the clinical management of uncomplicated chronic heartburn [5]. Another study claimed a good accuracy rate for cytological abnormalities (close to 80 % compared with histological changes) in esophagitis-negative patients [6], but the impact on further management is unclear.Other abstracts dealt with the decreasing incidence of peptic esophageal strictures [7], gastric hypersecretion in endoscopy-negative GERD [8], esophageal dysfunction in GERD associated with scleroderma [9], and dental erosions and GERD in children [10]. Laparoscopic and Surgical TreatmentTwo randomized trials comparing laparoscopic Nissen fundoplication (LNF) with medical therapy using proton-pump inhibitors (PPI) were presented this year. One study included 134 patients randomized from 219 GERD patients; the short-term results at three months showed a better De Meester score and quality of life in the LNF group [11]. The long-term outcome at five years in a Scandinavian study, apparently supported by AstraZeneca, showed a better outcome for LNF with regard to time to treatment failure. However, after dose adjustment in case of relapse in the medical group, the differences in the long-term outcome with regard to symptomatic and/or endoscopic relapse were no longer significant [12]. This means that both treatments a...