Controlling reflux - during anti-reflux surgery or by correcting medications with proton pump inhibitors - reduces the risk of progression to low or high degree dysplasia, adenocarcinoma or a combination of all three conditions - these data were presented during Digestive Disease Week 2014, which was held from May 3 to 6, 2014 in Chicago (USA).

Between January 2000 and November 2010, the researchers conducted a retrospective monocentric cohort study in 1,830 patients diagnosed with Barrett's esophagus. The main outcome measure was progression of disease to low or high grade dysplasia, adenocarcinoma or a combination of the three conditions. Out of 1,830 Barrett's esophagus patients, 102 people progressed to low grade dysplasia, high grade dysplasia or esophageal adenocarcinoma over an average of 5.5 years. The annual incidence of dysplasia or high-grade adenocarcinoma was 0.5%.

It turned out that more than 92% of the patients underwent reflux control and 72% had no regression of the disease. Older men are more prone to progression (69.3 years in the progression group versus 63.9 years in the group of patients in whom no progression was observed, p less than 0.001). Long length of the affected segment of the esophagus was also associated with an increased risk of disease progression (6.13 cm in patients with progression versus 2.68 cm in patients without progression); 20.3% of the patients in whom the process did not progress had a larger lesion size, compared to 58.5% of the patients who had a progression of the disease.

Patients who underwent surgery for Barrett's esophagus (n = 44) or who used proton pump inhibitors (n = 1708) noted disease progression with a lower frequency than patients who have not had any surgery or medication (relative risk 0.23, 95% confidence interval 0.12-0.42).

The limitations of this study were patient compliance with the use of proton pump inhibitors and the accuracy of medical records.

The researchers identified 5 independent risk factors for progression of Barrett's esophagus to esophageal dysplasia or adenocarcinoma. These are patients over 75 years old, the length of the affected segment, the lack of regression during treatment, candidiasis and uncontrolled reflux. It has been found that the risk of progression of the disease to dysplasia or adenocarcinoma in patients who do not control reflux is 5 times higher than in patients in whom reflux is controlled surgically or medically.

Thus, controlling reflux is the only modifiable risk factor directly linked to the progression of the disease.