Bile reflux in benign and malignant Barrett's esophagus: effect of medical acid suppression and Nissen fundoplication
Bile reflux has been implicated in the pathogenesis and malignant degeneration of Barrett's esophagus, but clinical studies in patients with adenocarcinoma arising in Barrett's esophagus are lacking. Ambulatory esophageal measurement of acid and bile reflux was performed with the previousl...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 1998-07, Vol.2 (4), p.333-341 |
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| description | Bile reflux has been implicated in the pathogenesis and malignant degeneration of Barrett's esophagus, but clinical studies in patients with adenocarcinoma arising in Barrett's esophagus are lacking. Ambulatory esophageal measurement of acid and bile reflux was performed with the previously validated fiberoptic bilirubin monitoring system (Bilitec) combined with a pH probe in 20 asymptomatic volunteers, 19 patients with gastroesophageal reflux disease (GERD) but no mucosal injury, 45 patients with GERD and erosive esophagitis, 33 patients with GERD and Barrett's esophagus, and 14 patients with early adenocarcinoma arising in Barrett's esophagus. Repeat studies were done in 15 patients under medical acid suppression and 16 patients after laparoscopic Nissen fundoplication. The mean esophageal bile exposure time showed an exponential increase from GERD patients without esophagitis to those with erosive esophagitis and benign Barrett's esophagus and was highest in patients with early carcinoma in Barrett's esophagus (
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| doi_str_mv | 10.1016/S1091-255X(98)80072-3 |
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P <0.01). Pathologic esophageal bile exposure was documented in 18 (54.5%) of 33 patients with benign Barrett's esophagus and 11 (78.6%) of 14 patients with early adenocarcinoma in Barrett's esophagus. Nissen fundoplication but not medical acid suppression resulted in complete suppression of bile reflux. Bile reflux into the esophagus is particularly prevalent in patients with Barrett's esophagus and early cancer. Bile reflux into the esophagus can be completely suppressed by Nissen fundoplication but not medical acid suppression alone.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1016/S1091-255X(98)80072-3</identifier><identifier>PMID: 9841990</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acids ; Adenocarcinoma - complications ; Adenocarcinoma - physiopathology ; Adult ; Anti-Ulcer Agents - therapeutic use ; Barrett Esophagus - complications ; Barrett Esophagus - physiopathology ; Bile - chemistry ; Bile Reflux - complications ; Bile Reflux - physiopathology ; Bile Reflux - prevention & control ; Bilirubin - analysis ; Cancer ; Enzyme Inhibitors - therapeutic use ; Esophageal Neoplasms - complications ; Esophageal Neoplasms - physiopathology ; Esophagitis, Peptic - complications ; Esophagitis, Peptic - physiopathology ; Esophagus - physiopathology ; Female ; Fiber Optic Technology - instrumentation ; Fundoplication ; Gastric Acid - chemistry ; Gastroesophageal Reflux - complications ; Gastroesophageal Reflux - physiopathology ; Humans ; Hydrogen-Ion Concentration ; Laparoscopy ; Male ; Middle Aged ; Monitoring systems ; Monitoring, Ambulatory ; Omeprazole - therapeutic use ; Proton Pump Inhibitors ; Throat</subject><ispartof>Journal of gastrointestinal surgery, 1998-07, Vol.2 (4), p.333-341</ispartof><rights>1998</rights><rights>The Society for Surgery of the Alimentary Tract, Inc. 1998</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c303t-de417cbd03b42fc318388e358a4ecc0d5f9cb3e259805bed2588f3892d6af2df3</citedby><cites>FETCH-LOGICAL-c303t-de417cbd03b42fc318388e358a4ecc0d5f9cb3e259805bed2588f3892d6af2df3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9841990$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stein, H.J.</creatorcontrib><creatorcontrib>Kauer, W.K.H.</creatorcontrib><creatorcontrib>Feussner, H.</creatorcontrib><creatorcontrib>Siewert, J.R.</creatorcontrib><title>Bile reflux in benign and malignant Barrett's esophagus: effect of medical acid suppression and Nissen fundoplication</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><description>Bile reflux has been implicated in the pathogenesis and malignant degeneration of Barrett's esophagus, but clinical studies in patients with adenocarcinoma arising in Barrett's esophagus are lacking. Ambulatory esophageal measurement of acid and bile reflux was performed with the previously validated fiberoptic bilirubin monitoring system (Bilitec) combined with a pH probe in 20 asymptomatic volunteers, 19 patients with gastroesophageal reflux disease (GERD) but no mucosal injury, 45 patients with GERD and erosive esophagitis, 33 patients with GERD and Barrett's esophagus, and 14 patients with early adenocarcinoma arising in Barrett's esophagus. Repeat studies were done in 15 patients under medical acid suppression and 16 patients after laparoscopic Nissen fundoplication. The mean esophageal bile exposure time showed an exponential increase from GERD patients without esophagitis to those with erosive esophagitis and benign Barrett's esophagus and was highest in patients with early carcinoma in Barrett's esophagus (
P <0.01). Pathologic esophageal bile exposure was documented in 18 (54.5%) of 33 patients with benign Barrett's esophagus and 11 (78.6%) of 14 patients with early adenocarcinoma in Barrett's esophagus. Nissen fundoplication but not medical acid suppression resulted in complete suppression of bile reflux. Bile reflux into the esophagus is particularly prevalent in patients with Barrett's esophagus and early cancer. Bile reflux into the esophagus can be completely suppressed by Nissen fundoplication but not medical acid suppression alone.</description><subject>Acids</subject><subject>Adenocarcinoma - complications</subject><subject>Adenocarcinoma - physiopathology</subject><subject>Adult</subject><subject>Anti-Ulcer Agents - therapeutic use</subject><subject>Barrett Esophagus - complications</subject><subject>Barrett Esophagus - physiopathology</subject><subject>Bile - chemistry</subject><subject>Bile Reflux - complications</subject><subject>Bile Reflux - physiopathology</subject><subject>Bile Reflux - prevention & control</subject><subject>Bilirubin - analysis</subject><subject>Cancer</subject><subject>Enzyme Inhibitors - therapeutic use</subject><subject>Esophageal Neoplasms - complications</subject><subject>Esophageal Neoplasms - physiopathology</subject><subject>Esophagitis, Peptic - complications</subject><subject>Esophagitis, Peptic - physiopathology</subject><subject>Esophagus - physiopathology</subject><subject>Female</subject><subject>Fiber Optic Technology - instrumentation</subject><subject>Fundoplication</subject><subject>Gastric Acid - chemistry</subject><subject>Gastroesophageal Reflux - complications</subject><subject>Gastroesophageal Reflux - physiopathology</subject><subject>Humans</subject><subject>Hydrogen-Ion Concentration</subject><subject>Laparoscopy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Monitoring systems</subject><subject>Monitoring, Ambulatory</subject><subject>Omeprazole - therapeutic use</subject><subject>Proton Pump Inhibitors</subject><subject>Throat</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkU1rFjEUhYMotVZ_QiEg-LEYzU0mMxk3YotfUHShgruQSW5qyrzJmExE_71p31cXblzlwjn35PIcQk6BPQMGw_NPwCbouJRfn0zqqWJs5J24RY5BjaLrBz7cbvMfy11yr5QrxmBkoI7I0aR6mCZ2TOpZWJBm9Ev9SUOkM8ZwGamJju7M0kYTN3pmcsZte1wolrR-M5e1vKDoPdqNJk936II1CzU2OFrqumYsJaR9yodQCkbqa3RpXZpva8p9csebpeCDw3tCvrx5_fn8XXfx8e3781cXnRVMbJ3DHkY7OybmnnsrQAmlUEhlerSWOeknOwvkclJMzui4VMoLNXE3GM-dFyfk0T53zel7xbLpXSgWl8VETLXoRgMkl9CMD_8xXqWaY7tNAwAXwwisby65d9mcSmnQ9JrDzuRfGpi-LkXflKKvietJ6ZtStGh7p4f0OjdYf7cOLTT95V7HxuJHwKyLDRht45obY-1S-M8PvwHmvZ2T</recordid><startdate>199807</startdate><enddate>199807</enddate><creator>Stein, H.J.</creator><creator>Kauer, W.K.H.</creator><creator>Feussner, H.</creator><creator>Siewert, J.R.</creator><general>Elsevier Inc</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>199807</creationdate><title>Bile reflux in benign and malignant Barrett's esophagus: effect of medical acid suppression and Nissen fundoplication</title><author>Stein, H.J. ; Kauer, W.K.H. ; Feussner, H. ; Siewert, J.R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c303t-de417cbd03b42fc318388e358a4ecc0d5f9cb3e259805bed2588f3892d6af2df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Acids</topic><topic>Adenocarcinoma - complications</topic><topic>Adenocarcinoma - physiopathology</topic><topic>Adult</topic><topic>Anti-Ulcer Agents - therapeutic use</topic><topic>Barrett Esophagus - complications</topic><topic>Barrett Esophagus - physiopathology</topic><topic>Bile - chemistry</topic><topic>Bile Reflux - complications</topic><topic>Bile Reflux - physiopathology</topic><topic>Bile Reflux - prevention & control</topic><topic>Bilirubin - analysis</topic><topic>Cancer</topic><topic>Enzyme Inhibitors - therapeutic use</topic><topic>Esophageal Neoplasms - complications</topic><topic>Esophageal Neoplasms - physiopathology</topic><topic>Esophagitis, Peptic - complications</topic><topic>Esophagitis, Peptic - physiopathology</topic><topic>Esophagus - physiopathology</topic><topic>Female</topic><topic>Fiber Optic Technology - instrumentation</topic><topic>Fundoplication</topic><topic>Gastric Acid - chemistry</topic><topic>Gastroesophageal Reflux - complications</topic><topic>Gastroesophageal Reflux - physiopathology</topic><topic>Humans</topic><topic>Hydrogen-Ion Concentration</topic><topic>Laparoscopy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Monitoring systems</topic><topic>Monitoring, Ambulatory</topic><topic>Omeprazole - therapeutic use</topic><topic>Proton Pump Inhibitors</topic><topic>Throat</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stein, H.J.</creatorcontrib><creatorcontrib>Kauer, W.K.H.</creatorcontrib><creatorcontrib>Feussner, H.</creatorcontrib><creatorcontrib>Siewert, J.R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stein, H.J.</au><au>Kauer, W.K.H.</au><au>Feussner, H.</au><au>Siewert, J.R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bile reflux in benign and malignant Barrett's esophagus: effect of medical acid suppression and Nissen fundoplication</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><addtitle>J Gastrointest Surg</addtitle><date>1998-07</date><risdate>1998</risdate><volume>2</volume><issue>4</issue><spage>333</spage><epage>341</epage><pages>333-341</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Bile reflux has been implicated in the pathogenesis and malignant degeneration of Barrett's esophagus, but clinical studies in patients with adenocarcinoma arising in Barrett's esophagus are lacking. Ambulatory esophageal measurement of acid and bile reflux was performed with the previously validated fiberoptic bilirubin monitoring system (Bilitec) combined with a pH probe in 20 asymptomatic volunteers, 19 patients with gastroesophageal reflux disease (GERD) but no mucosal injury, 45 patients with GERD and erosive esophagitis, 33 patients with GERD and Barrett's esophagus, and 14 patients with early adenocarcinoma arising in Barrett's esophagus. Repeat studies were done in 15 patients under medical acid suppression and 16 patients after laparoscopic Nissen fundoplication. The mean esophageal bile exposure time showed an exponential increase from GERD patients without esophagitis to those with erosive esophagitis and benign Barrett's esophagus and was highest in patients with early carcinoma in Barrett's esophagus (
P <0.01). Pathologic esophageal bile exposure was documented in 18 (54.5%) of 33 patients with benign Barrett's esophagus and 11 (78.6%) of 14 patients with early adenocarcinoma in Barrett's esophagus. Nissen fundoplication but not medical acid suppression resulted in complete suppression of bile reflux. Bile reflux into the esophagus is particularly prevalent in patients with Barrett's esophagus and early cancer. Bile reflux into the esophagus can be completely suppressed by Nissen fundoplication but not medical acid suppression alone.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>9841990</pmid><doi>10.1016/S1091-255X(98)80072-3</doi><tpages>9</tpages></addata></record> |
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| ispartof | Journal of gastrointestinal surgery, 1998-07, Vol.2 (4), p.333-341 |
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| subjects | Acids Adenocarcinoma - complications Adenocarcinoma - physiopathology Adult Anti-Ulcer Agents - therapeutic use Barrett Esophagus - complications Barrett Esophagus - physiopathology Bile - chemistry Bile Reflux - complications Bile Reflux - physiopathology Bile Reflux - prevention & control Bilirubin - analysis Cancer Enzyme Inhibitors - therapeutic use Esophageal Neoplasms - complications Esophageal Neoplasms - physiopathology Esophagitis, Peptic - complications Esophagitis, Peptic - physiopathology Esophagus - physiopathology Female Fiber Optic Technology - instrumentation Fundoplication Gastric Acid - chemistry Gastroesophageal Reflux - complications Gastroesophageal Reflux - physiopathology Humans Hydrogen-Ion Concentration Laparoscopy Male Middle Aged Monitoring systems Monitoring, Ambulatory Omeprazole - therapeutic use Proton Pump Inhibitors Throat |
| title | Bile reflux in benign and malignant Barrett's esophagus: effect of medical acid suppression and Nissen fundoplication |
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