Gastroesophageal reflux disease (GERD) is a common clinical problem. Circumstantial evidence continues to suggest that infection with Helicobacter pylori may protect some patients from developing GERD and its complications. An empirical trial of a proton-pump inhibitor may now be a reasonable alternative to endoscopy or 24-hour pH testing for the diagnosis of GERD. Long-term follow-up data covering more than over a decade indicate that proton-pump inhibitors are effective and safe agents for the treatment of GERD. Furthermore, a strategy of proton-pump inhibitors first may be the most cost-effective approach to GERD. It remains unclear why some patients with GERD develop Barrett's esophagus, whereas others do not. Recent studies demonstrate the importance of pulses of acid or bile in increasing cell proliferation and cyclooxygenase-2 expression in Barrett's epithelium cell cultures. Short-segment Barrett's esophagus is now clearly associated with an increased risk of dysplasia or cancer compared to intestinal metaplasia of the cardia, and the cancer risk in this condition is similar to that with long-segment Barrett's esophagus. However, the overall cancer risk in patients with Barrett's esophagus is lower than previously estimated, at approximately 0.5 % annually. Ablation techniques continue to show promise, but are not yet ready for routine clinical use. Endoscopic mucosal resection is a new treatment option for selected patients with high-grade dysplasia or superficial esophageal adenocarcinoma.
References
-
1
Valle C, Broglia F, Pistoria A, et al.
Prevalence and impact of symptoms suggestive of gastroesophageal reflux disease.
Dig Dis Sci.
1999;
44
1848-1852
-
2
Henke C J, Levin T R, Henning J M, et al.
Work loss due to peptic ulcer disease and gastroesophageal reflux disease in a health maintenance organization.
Am J Gastroenterol.
2000;
95
788-792
-
3
Lagergren J, Bergstrom R, Nyren O.
No relation between body mass and gastro-oesophageal reflux symptoms in a Swedish population based study.
Gut.
2000;
47
26-29
-
4
Wilson L J, Ma W, Hirschowitz B I.
Association of obesity with hiatal hernia and esophagitis.
Am J Gastroenterol.
1999;
94
2840-2844
-
5
Hu F, Preston P A, Post J C, et al.
Mapping of a gene for severe pediatric gastroesophageal reflux to chromosome 13q14.
JAMA.
2000;
284
325-334
-
6
O'Connor H J.
Helicobacter pylori and gastro-oesophageal reflux disease: clinical implications and management.
Aliment Pharmacol Ther.
1999;
13
117-127
-
7
Wu J C, Sung J J, Ng E K, et al.
Prevalence and distribution of Helicobacter pylori in gastroesophageal reflux disease: a study from the East.
Am J Gastroenterol.
1999;
94
1790-1794
-
8
Haruma K, Hamada H, Mihara M, et al.
Negative association between Helicobacter pylori infection and reflux esophagitis in older patients: case-control study in Japan.
Helicobacter.
2000;
5
24-29
-
9
Schenk B E, Kuipers E J, Klinkenberg-Knol E C, et al.
Helicobacter pylori and the efficacy of omeprazole therapy for gastroesophageal reflux disease.
Am J Gastroenterol.
1999;
94
884-887
-
10
Wu J C, Sung J J, Chan F K.
Helicobacter pylori infection is associated with milder gastro-oesophageal reflux disease.
Aliment Pharmacol Ther.
2000;
4
427-432
-
11
El-Serag H B, Sonnenberg A, Jamal M M, et al.
Corpus gastritis is protective against reflux oesophagitis.
Gut.
1999;
45
181-185
-
12
Fallone C A, Barkun A N, Friedman G, et al.
Is Helicobacter pylori eradication associated with gastroesophageal reflux disease?.
Am J Gastroenterol.
2000;
95
914-920
-
13
Vakil N, Hahn B, McSorley D.
Recurrent symptoms and gastro-oesophageal reflux disease in patients with duodenal ulcer treated for Helicobacter pylori infection.
Aliment Pharmacol Ther.
2000;
14
45-51
-
14
McColl K E, Dickson A, El-Nujumi A, et al.
Symptomatic benefit 1 - 3 years after H. pylori eradication in ulcer disease: impact of gastroesophageal reflux disease.
Am J Gastroenterol.
2000;
95
101-105
-
15
Dent J, Brun J, Fendrick A M, et al.
An evidence-based appraisal of reflux disease management: the Genval workshop report.
Gut.
1999;
(Suppl 2)
S1-16
-
16
Nandurkar S, Talley N J, Martin C J, et al.
Esophageal histology does not provide additional useful information over clinical assessment in identifying reflux patients presenting for esophagogastroduodenoscopy.
Dig Dis Sci.
2000;
45
217-224
-
17
Fass R, Ofman J J, Gralnek I M, et al.
Clinical and economic assessment of the omeprazole test in patients with symptoms suggestive of gastroesophageal reflux disease.
Arch Intern Med.
1999;
159
2161-2168
-
18
Fass R, Ofman J J, Sampliner R E, et al.
The omeprazole test is as sensitive as 24-h oesophageal pH monitoring in diagnosing gastro-oesophageal reflux disease in symptomatic patients with erosive esophagitis.
Aliment Pharmacol Ther.
2000;
14
389-396
-
19
Fass R, Hell R, Sampliner R E, et al.
Effect of ambulatory 24-hour esophageal pH monitoring on reflux-provoking activities.
Dig Dis Sci.
1999;
44
2263-2269
-
20
Klingler P J, Hinder R A, Wetscher G J, et al.
Accurate placement of the esophageal pH electrode for 24-hour pH monitoring using a combined pH/manometry probe.
Am J Gastroenterol.
2000;
95
906-909
-
21
Kiljander T O, Salomaa E R, Hietanen E K, et al.
Gastroesophageal reflux in asthmatics: a double-blind, placebo-controlled crossover study with omeprazole.
Chest.
1999;
116
1257-1264
-
22
Spivack H, Smith D, Phichith A, et al.
Asthma and gastroesophageal reflux: fundoplication decreases need for systemic corticosteroids.
J Gastrointest Surg.
1999;
3
477-482
-
23
Ours T M, Kavuru M S, Schilz R J, Richter J E.
A prospective evaluation of esophageal testing and a double-blind, randomized study of omeprazole in a diagnostic and therapeutic algorithm for chronic cough.
Am J Gastroenterol.
1999;
94
3131-3138
-
24
Gerson L B, Robbins A S, Garber A, et al.
A cost-effectiveness analysis of prescribing strategies in the management of gastroesophageal reflux disease.
Am J Gastroenterol.
2000;
95
395-407
-
25
Richter J E, Campbell D R, Kahrilas P J, et al.
Lansoprazole compared with ranitidine for the treatment of nonerosive gastroesophageal reflux disease.
Arch Intern Med.
2000;
160
1803-1809
-
26
Richter J E, Peura D, Benjamin S B, et al.
Efficacy of omeprazole for the treatment of symptomatic acid reflux disease without esophagitis.
Arch Intern Med.
2000;
160
1810-1816
-
27
Klinkenberg-Knol E C, Nelis F, Dent J, et al.
Long-term omeprazole treatment in resistant gastroesophageal reflux disease: efficacy, safety, and influence on gastric mucosa.
Gastroenterology.
2000;
118
661-669
-
28
Lundell L, Miettinen P, Myrvold H E, et al.
Lack of effect of acid suppression therapy on gastric atrophy.
Gastroenterology.
1999;
117
319-326
-
29
Gillen D, Wirz A A, Neithercut W D, et al.
Helicobacter pylori infection potentiates the inhibition of gastric acid secretion by omeprazole.
Gut.
1999;
44
468-475
-
30
Holtmann G, Cain C, Malfertheiner P.
Gastric Helicobacter pylori infection accelerates healing of reflux esophagitis during treatment with the proton pump inhibitor pantoprazole.
Gastroenterology.
1999;
117
11-16
-
31
Bais J E, Bartelsman J F, Bonjer H J, et al.
Laparoscopic or conventional Nissen fundoplication for gastro-oesophageal reflux disease: a randomised clinical trial.
Lancet.
2000;
355
170-174
-
32
Kamolz T, Bammer T, Wykpiel H, et al.
Quality of life and surgical outcome after laparoscopic Nissen and Toupet fundoplication: one-year follow-up.
Endoscopy.
2000;
32
363-368
-
33
Utley D S, Kim M, Vierra M A, Triadafilopoulos G.
Augmentation of lower esophageal sphincter pressure and gastric yield pressure after radiofrequency energy delivery to the gastroesophageal junction: a porcine model.
Gastrointest Endosc.
2000;
52
81-86
-
34
Eloubeidi M A, Provenzale D.
Health-related quality of life and severity of symptoms in patients with Barrett's esophagus and gastroesophageal reflux disease without Barrett's esophagus.
Am J Gastroenterol.
2000;
95
1881-1887
-
35
Kaur B S, Ouatu-Lascar R, Omary M B, et al.
Bile salts induce or blunt cell proliferation in Barrett's esophagus in an acid-dependent fashion.
Am J Physiol.
2000;
278
G1000-G1009
-
36
Shirvani V N, Ouatu-Lascar R, Kaur B S, et al.
Cyclooxygenase 2 expression in Barrett's esophagus and adenocarcinoma: ex vivo induction by bile salts and acid exposure.
Gastroenterology.
2000;
118
487-496
-
37
Lord R V, Frommer D J, Inder S, et al.
Prevalence of Helicobacter pylori infection in 160 patients with Barrett's oesophagus or Barrett's adenocarcinoma.
Aust NZ J Surg.
2000;
70
26-33
-
38
Weston A P, Badr A S, Topalovski M, et al.
Prospective evaluation of the prevalence of gastric Helicobacter pylori infection in patients with GERD, Barrett's esophagus, Barrett's dysplasia, and Barrett's adenocarcinoma.
Am J Gastroenterol.
2000;
95
387-394
-
39
Sampliner R E.
Practice guidelines on the diagnosis, surveillance, and therapy of Barrett's esophagus.
Am J Gastroenterol.
1998;
93
1028-1032
-
40
Soni A, Sampliner R E, Sonnenberg A.
Screening for high-grade dysplasia in gastroesophageal reflux disease: is it cost-effective?.
Am J Gastroenterol.
2000;
95
2089-2093
-
41
Ormsby A H, Vaezi M F, Richter J E, et al.
Cytokeratin immunoreactivity patterns in the diagnosis of short-segment Barrett's esophagus.
Gastroenterology.
2000;
119
683-690
-
42
Sharma P, Morales T G, Sampliner R E.
Short segment Barrett's esophagus: the need for standardization of the definition and of endoscopic criteria.
Am J Gastroenterol.
1998;
93
1033-1036
-
43
Sharma P, Weston A P, Morales T, et al.
Relative risk of dysplasia for patients with intestinal metaplasia in the distal esophagus and in the gastric cardia.
Gut.
2000;
46
9-13
-
44
Rudolph R E, Vaughan T L, Storer B E, et al.
Effect of segment length for neoplastic progression in patients with Barrett's esophagus.
Ann Intern Med.
2000;
132
612-620
-
45
Lagergren J, Bergstrom R, Adami H O, et al.
Association between medications that relax lower esophageal sphincter and risk for esophageal adenocarcinoma.
Ann Intern Med.
2000;
133
165-171
-
46
O'Connor J B, Falk G W, Richter J E.
The incidence of adenocarcinoma and dysplasia in Barrett's esophagus: report on the Cleveland Clinic Barrett's esophagus registry .
Am J Gastroenterol.
1999;
94
2037-2042
-
47
Shaheen N J, Crosby M A, Bozymski E M, Sandler R S.
Is there publication bias in the reporting of cancer risk in Barrett's esophagus?.
Gastroenterology.
2000;
119
333-338
-
48
Levine D S, Blount P L, Rudolph R E, et al.
Safety of a systematic endoscopic biopsy protocol in patients with Barrett's esophagus.
Am J Gastroenterol.
2000;
95
1152-1157
-
49
Falk G W, Ours T M, Richter J E.
Practice patterns for surveillance of Barrett's esophagus in the USA.
Gastrointest Endosc.
2000;
52
197-203
-
50
Gross C P, Canto M I, Hixson J, et al.
Management of Barrett's esophagus: a national study of practice patterns and their cost implications.
Am J Gastroenterol.
1999;
94
3340-3347
-
51
Van Sandick J W, Bartelsman J F, Van Lanschot J J, et al.
Surveillance of Barrett's oesophagus: physicians' practices and review of current guidelines.
Eur J Gastroenterol Hepatol.
2000;
12
111-117
-
52
Provenzale D, Schmitt C, Wong J B.
Barrett's esophagus: a new look at surveillance based on emerging estimates of cancer risk.
Am J Gastroenterol.
1999;
94
2043-2053
-
53
Weston A P, Badr A S, Hassanein R S.
Prospective multivariate analysis of clinical, endoscopic, and histological factors predictive of the development of Barrett's multifocal high-grade dysplasia or adenocarcinoma.
Am J Gastroenterol.
1999;
94
3413-3419
-
54
Reid B J, Levine D S, Longton G, et al.
Predictors of progression to cancer in Barrett's esophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets.
Am J Gastroenterol.
2000;
95
1669-1676
-
55
Weston A P, Sharma P, Topalovski M, et al.
Long-term follow-up of Barrett's high-grade dysplasia.
Am J Gastroenterol.
2000;
95
1888-1893
-
56
Fass R, Sampliner R E, Malagon I B, et al.
Failure of oesophageal acid control in candidates for Barrett's oesophagus reversal on a very high dose of proton pump inhibitor.
Aliment Pharmacol Ther.
2000;
14
597-602
-
57
Montes C G, Brandalise N A, Deliza R, et al.
Antireflux surgery followed by bipolar electrocoagulation in the treatment of Barrett's esophagus.
Gastrointest Endosc.
1999;
5
173-177
-
58
Pereira-Lima J C, Busnello J V, Saul C, et al.
High power setting argon plasma coagulation for the eradication of Barrett's esophagus.
Am J Gastroenterol.
2000;
95
1661-1668
-
59
Schulz H, Miehlke S, Antos D, et al.
Ablation of Barrett's epithelium by endoscopic argon plasma coagulation in combination with high-dose omeprazole.
Gastrointest Endosc.
2000;
51
659-663
-
60
Krishnadath K K, Wang K K, Taniguchi K, et al.
Persistent genetic abnormalities in Barrett's esophagus after photodynamic therapy.
Gastroenterology.
2000;
119
624-630
-
61
Van Laetham J L, Peny M O, Salmon I, et al.
Intramucosal adenocarcinoma arising under squamous re-epithelialisation of Barrett's oesophagus.
Gut.
2000;
46
574-577
-
62
Ell C, May A, Gossner L, et al.
Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus.
Gastroenterology.
2000;
118
670-677
-
63
Sabik J F, Rice T W, Goldblum J R, et al.
Superficial esophageal carcinoma.
Ann Thorac Surg.
1995;
60
896-902
Dr. G. W. Falk
Dept. of Gastroenterology, Desk S-40
The Cleveland Clinic Foundation
9500 Euclid Avenue
Cleveland, Ohio 44195
USA
Fax: Fax:+ 1-216-444-9416
Email: E-mail:falkg@ccf.org
