Strong Intra-Esophageal Reflux May Contribute to the Development of Barrett’s Adenocarcinoma and Affect the Localization

Saito, Masahiro; Koike, Tomoyuki; Nakagawa, Kenichiro; Abe, Yuina; Norita, Kazuaki; Kikuchi, H; Kanno, Takeshi; Hatta, Waku; Ara, Nobuyuki; Uno, Kaname; Asanuma, Kiyotaka; Asano, Naoki; Imatani, Akira; Shimosegawa, Tooru; Masamune, Atsushi

doi:10.1159/000502377

Cited by 6 publications

(7 citation statements)

References 66 publications

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“…It could be argued that a higher TDRE documents a more severe degree of GERD, since there is evidence that a higher TDRE correlates with increasing grades of esophagitis and Barrett’s esophagus. [ 34 , 35 ] Therefore, refractory GERD patients with evidence of an elevated number of TDRE at preoperative MII-pH monitoring may be offered LARS bust should be aware of a potential higher risk of dissatisfaction after the procedure compared to patients with normal TDRE.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic antireflux surgery for refractory gastroesophageal reflux disease: long-term clinical outcomes

et al. 2023

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Persistent symptoms despite adequate Proton Pump Inhibitors (PPI) treatment are described in up to 40% of patients with Gastroesophageal Reflux Disease (GERD). The efficacy of Laparoscopic Antireflux Surgery (LARS) in PPI non-responder patients is still unclear. This observational study aims to report the long-term clinical outcomes and predictors of dissatisfaction in a cohort of refractory GERD patients submitted to LARS. Patients with preoperative refractory symptoms and objective GERD evidence submitted to LARS between 2008 and 2016 were included in the study. Primary endpoint was overall satisfaction with the procedure, secondary endpoints were long-term GERD symptom relief and endoscopic findings. Univariate and multivariate analyses were performed to compare satisfied and dissatisfied patients, in order to identify preoperative predictors of dissatisfaction. A total of 73 refractory GERD patients who underwent LARS were included in the study. At a mean follow-up of 91.2 ± 30.5 months, the satisfaction rate was 86.3%, with a statistically significant reduction in typical and atypical GERD symptoms. Causes of dissatisfaction were severe heartburn (6.8%), gas bloat syndrome (2.8%), and persistent dysphagia (4.1%). Multivariate analysis showed that a number of Total Distal Reflux Episodes (TDRE) > 75 was a predictive factor of long-term dissatisfaction after LARS while a partial response to PPI was a protective factor against dissatisfaction. LARS guarantees a high level of long-term satisfaction for selected refractory GERD patients. An abnormal TDRE at 24 h-multichannel intraluminal impedance-pH monitoring and the lack of response to preoperative PPI were predictors of long-term dissatisfaction.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic antireflux surgery for refractory gastroesophageal reflux disease: long-term clinical outcomes

et al. 2023

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“…A study comparing reflux metrics in patients with endoscopically treated Barrett's‐related adenocarcinoma with non‐dysplastic BE found that the total number of reflux events was greater in the adenocarcinoma group (67) compared with the BE group (45, p = 0.046). The number of acidic events (19 vs. 16) was similar, but the adenocarcinoma group had greater number of weakly acidic events (34 vs. 21, p = 0.09) and alkaline events (2 vs. 0, p = 0.042) 87 …”

Section: Esophageal Cancermentioning

confidence: 84%

A perspective on the clinical relevance of weak or nonacid reflux

Jodorkovsky,

Katzka,

Gyawali

2023

Neurogastroenterology Motil

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BackgroundAdvances in ambulatory esophageal reflux monitoring that incorporated impedance electrodes to pH catheters have resulted in better characterization of retrograde bolus flow in the esophagus. With pH‐impedance monitoring, in addition to acid reflux episodes identified by pH drops below 4.0, weakly acid reflux (WAR, pH 4–7) and nonacid reflux (NAR, pH >7.0) are also recognized, although both may be included under the umbrella term NAR. However, despite identification of ambulatory pH‐impedance monitoring, data on clinical relevance and prognostic value of NAR are limited. The Lyon Consensus, an international expert review that defines conclusive metrics for gastroesophageal reflux disease (GERD), identifies NAR as “supportive” but not conclusive for GERD.PurposeThis review provides perspectives on whether NAR fulfills three criteria for clinical relevance: whether NAR sufficiently explains pathogenesis of symptoms, whether it is associated with meaningful manifestations of GERD, and whether it can predict treatment efficacy.

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“…The incidence of Barrett's adenocarcinoma (BA) has remarkably increased 3-to 6-fold in the past 20 to 40 years in Western countries and is becoming more common in Japan with time (1)(2)(3)(4)(5). BA is associated with a poor prognosis due to high rates of metastasis when detected at an advanced stage (6).…”

Section: Introductionmentioning

confidence: 99%

Linked-color Imaging May Help Improve the Visibility of Superficial Barrett's Esophageal Adenocarcinoma by Increasing the Color Difference

et al. 2021

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Objective Linked-color imaging (LCI), a new technology for image-enhanced endoscopy, emphasizes the color of the mucosa, and its practicality in the detection of early gastric and colon cancers has been reported. However, whether or not LCI is useful for the diagnosis of Barrett's adenocarcinoma (BA) has been unclear. In this study, we explored whether or not LCI enhances the color difference between a BA lesion and the surrounding mucosa. Methods Twenty-one lesions from 20 consecutive patients with superficial BA who underwent endoscopic submucosal dissection between November 2014 and September 2017 were retrospectively examined. The color differences (ΔE*) between the inside and outside of the lesion were evaluated retrospectively using white-light imaging (WLI), blue-light imaging (BLI), and LCI objectively, based on a Commission Internationale de l'Eclairage (CIE) lab color system. Furthermore, we compared the morphology, color, and circumferential location of the lesion. ResultsThe median values of the color difference (ΔE*) in WLI and BLI were 9.1 and 5.8, respectively, and no difference was observed. In LCI, the median color difference was 17.6, which was higher than that of WLI and BLI. Regardless of the morphology, color, and circumferential location of BA lesions, the color difference was larger in LCI than in WLI. Conclusion LCI increases the color difference between the BA and the surrounding Barrett's mucosa.

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Strong Intra-Esophageal Reflux May Contribute to the Development of Barrett’s Adenocarcinoma and Affect the Localization

Cited by 6 publications

References 66 publications

Laparoscopic antireflux surgery for refractory gastroesophageal reflux disease: long-term clinical outcomes

Laparoscopic antireflux surgery for refractory gastroesophageal reflux disease: long-term clinical outcomes

A perspective on the clinical relevance of weak or nonacid reflux

Linked-color Imaging May Help Improve the Visibility of Superficial Barrett's Esophageal Adenocarcinoma by Increasing the Color Difference

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