REGRESSION AND PROGRESSION OF BARRETTS-ESOPHAGUS AFTER ANTIREFLUX SURGERY

The effects of antireflux surgery on Barrett's oesophagus were studied . Fifty-six patients (45 men and 11 women of median age 48.5 (range 20 -78) years) with histologically confirmed Barrett's oesophagus (greate r than 3 cm in length) and gastro-oesophageal reflux underwent antiref lux surgery. Symptoms were noted and patients underwent manometry and pH recording before and after operation, and annual flexible endoscopy . Fundoplication resulted in a significant improvement in lower oesoph ageal sphincter pressure (median (interquartile range (i.q.r.)) 8 (5-1 4) mmHg before operation versus 17 (11-22) mmHg after operation, P < 0 .001). Twenty-four of the 56 patients had partial or complete regressi on of Barrett's oesophagus (median (i.q.r.) length 8 (3-18) cm before versus 4 (0-10) cm after operation, P < 0.001) but nine showed progres sion (median (i.q.r.) length 6 (3-11) cm before versus 10 (6-15) cm af ter operation, P < 0.01) (median follow-up 5.5 (range 2.0-10.5) years) . Carcinoma developed in one patient. The length of Barrett's oesophag us was unchanged in 23 patients. Regression was more likely to occur i n patients who underwent fundoplication with previous or concomitant v agotomy (chi(2) = 7.21, 1 d.f., P < 0.01) and in those with a good sym ptomatic result (chi(2) = 23.52, 1 d.f., P < 0.001).