Efficacy of medical therapy and antireflux surgery to prevent Barrett's metaplasia in patients with gastroesophageal reflux disease

Objective To investigate whether Barrett's metaplasia may develop despite e ffective medical therapy. Summary Background Data Gastroesophageal reflux disease has a multifactoria l etiology Therefore, medical treatment may not prevent complications of re flux disease, Methods Eighty-three patients with reflux disease and mild esophagitis were prospectively studied for the development of Barrett's metaplasia while re ceiving long-term therapy with proton pump inhibitors and cisapride. Only p atients who had effective control of reflux symptoms and esophagitis were i ncluded. The surveillance time was 2 years. The outcome of these 83 patient s was compared with that of 42 patients in whom antireflux surgery was perf ormed with a median follow-up of 3.5 years. Results Twelve (14.5%) patients developed Barrett's while receiving medical therapy; this was not seen after surgery. Patients developing Barrett's ha d a weaker lower esophageal sphincter and peristalsis before treatment than patients with uncomplicated disease. Conclusions Antireflux surgery is superior to medical therapy in the preven tion of Barrett's metaplasia. Therefore, patients with reflux disease who h ave a weak lower esophageal sphincter and poor esophageal peristalsis shoul d undergo antireflux surgery, even if they have only mild esophagitis.