Is there any relationship between esophageal adenocarcinoma and anti-reflux surgery?

Authors S.N. Sgouros, H. Nastos.


Esophageal adenocarcinoma presents a more rapidly rising
incidence than all other cancers and arises in most patients
from its premalignant precursor, Barretts esophagus.
Barrets esophagus is associated with chronic GERD and
represents the severest form of this disease. PPIs can
markedly decrease acid reflux, but only antireflux surgery
can successfully restore the function of the incompetent
antireflux barrier. Antireflux surgery may be superior to
controlling acid reflux alone, because it also eliminates the
possible dangerous contributions of bile salts and
pancreatic enzymes. However, current data suggest that both
medical and surgical therapies are very effective in symptom
relief and healing of esophagitis over the long term, but
neither treatment predictably causes Barretts metaplasia to
regress, nor protects the patient from subsequently
developing adenocarcinoma of the esophagus. Even if
antireflux surgery could prevent esophageal cancer, its use
only for this purpose could not be justified because the
surgical mortality rate, at least 0,2%, far exceeds the annual
incidence of cancer, estimated at 0,07%. Therefore, it seems
prudent for gastroenterologists and surgeons to be honest
with their patients about the outcomes of current
established treatments of GERD. Given this information,
and after a thoughtful discussion of both therapies, we
believe patients can choose the regimen that best suits their
individual needs. Key words: GERD, Barretts esophagus, antireflux surgery,
esophageal adenocarcinoma.
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