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uklibk.ac.at
OBJECTIVE: To investigate whether Barrett's metaplasia may develop despite effective medical therapy. SUMMARY BACKGROUND DATA: Gastroesophageal reflux disease has a multifactorial etiology. Therefore, medical treatment may not prevent complications of reflux disease. METHODS: Eighty-three patients with reflux disease and mild esophagitis were prospectively studied for the development of Barrett's metaplasia while receiving long-term therapy with proton pump inhibitors and cisapride. Only patients who had effective control of reflux symptoms and esophagitis were included. The surveillance time was 2 years. The outcome of these 83 patients was compared with that of 42 patients in whom antireflux surgery was performed 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 had a weaker lower esophageal sphincter and peristalsis before treatment than patients with uncomplicated disease. CONCLUSIONS: Antireflux surgery is superior to medical therapy in the prevention of Barrett's metaplasia. Therefore, patients with reflux disease who have a weak lower esophageal sphincter and poor esophageal peristalsis should undergo antireflux surgery, even if they have only mild esophagitis.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11685025&dopt=Abstract
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u.washington.edu
A panel of international gastroenterologists and other specialists convened at a Takeda-sponsored symposium held during the XIIIth International Workshop on Gastroduodenal Pathology and Helicobacter pylori (October 2000, Rome) to discuss clinical management of H. pylori. Topics such as management strategies as alternatives to eradication, long-term outcomes, and the impact of antibiotic resistance to H. pylori were discussed in an interactive session. The panel concluded that 1) patients with ulcer-like or reflux-like dyspepsia do appear to benefit from proton pump inhibitor therapy, 2) eradication of H. pylori may reduce future morbidity and mortality from peptic ulcer disease and gastric carcinoma, outweighing the theoretical risk of developing gastro-oesophageal reflux disease, Barrett's oesophagus, and oesophageal adenocarcinoma, and 3) the epidemiology of resistance to H. pylori, and the impact of the percentage of eradication, should be considered when an eradication regimen is being planned for patients with non-ulcer dyspepsia. Susceptibility testing may be of help in areas where this investigation is cost effective.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11686229&dopt=Abstract
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medizin.uni-magdeburg.de
Several large studies investigating the benefit of eradicating Helicobacter pylori in patients with functional dyspepsia have reported varying results, and therefore questions about the clinical management of H. pylori infection remain. The ELAN study, a recent large multicentre, randomized study, compared eradication of H. pylori (with lansoprazole and antibiotics) with acid-suppressant treatment alone (lansoprazole) in H. pylori-associated functional dyspepsia. Investigators found that eradication led to improvement of dyspeptic symptoms. Although the symptomatic benefit was limited to a small subset of patients (approximately 9%) with H. pylori-positive functional dyspepsia, cure of chronic gastritis can be offered to the majority of patients (approximately 80%) and thus, in addition to the elimination of symptoms in some, the key risk factor for gastroduodenal pathology is eliminated. This study provides support for the recommendations of Maastricht 2, which found that H. pylori eradication is an appropriate therapeutic option for functional dyspepsia.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11686231&dopt=Abstract
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