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Proton Pump Inhibitors and Radiofrequency Ablation for Treatment of Barrett's Esophagus

[ Vol. 20 , Issue. 11 ]

Author(s):

Predrag Dugalic*, Srdjan Djuranovic, Aleksandra Pavlovic-Markovic, Vladimir Dugalic, Ratko Tomasevic, Zoran Gluvic, Milan Obradovic, Vladan Bajic and Esma R. Isenovic*   Pages 975 - 987 ( 13 )

Abstract:


Gastroesophageal Reflux Disease (GERD) is characterized by acid and bile reflux in the distal oesophagus, and this may cause the development of reflux esophagitis and Barrett’s oesophagus (BE). The natural histological course of untreated BE is non-dysplastic or benign BE (ND), then lowgrade (LGD) and High-Grade Dysplastic (HGD) BE, with the expected increase in malignancy transfer to oesophagal adenocarcinoma (EAC). The gold standard for BE diagnostics involves high-resolution white-light endoscopy, followed by uniform endoscopy findings description (Prague classification) with biopsy performance according to Seattle protocol. The medical treatment of GERD and BE includes the use of proton pump inhibitors (PPIs) regarding symptoms control. It is noteworthy that longterm use of PPIs increases gastrin level, which can contribute to transfer from BE to EAC, as a result of its effects on the proliferation of BE epithelium. Endoscopy treatment includes a wide range of resection and ablative techniques, such as radio-frequency ablation (RFA), often concomitantly used in everyday endoscopy practice (multimodal therapy). RFA promotes mucosal necrosis of treated oesophagal region via high-frequency energy. Laparoscopic surgery, partial or total fundoplication, is reserved for PPIs and endoscopy indolent patients or in those with progressive disease. This review aims to explain distinct effects of PPIs and RFA modalities, illuminate certain aspects of molecular mechanisms involved, as well as the effects of their concomitant use regarding the treatment of BE and prevention of its transfer to EAC.

Keywords:

GERD, Barrett’s oesophagus, proton pump inhibitors, radio-frequency ablation, action of PPIs, oesophagus.GERD, Barrett’s oesophagus, proton pump inhibitors, radio-frequency ablation, action of PPIs, oesophagus.

Affiliation:

University Clinical-Hospital Centre Zemun-Belgrade, Department of Gastroenterology and Hepatology, Belgrade, Clinical Centre of Serbia, Clinic for Gastroenterology and Hepatology, Faculty of Medicine, University of Belgrade, Belgrade, Clinical Centre of Serbia, Clinic for Gastroenterology and Hepatology, Faculty of Medicine, University of Belgrade, Belgrade, Clinical Centre of Serbia, Clinic for Surgery, Faculty of Medicine, University of Belgrade, Belgrade, University Clinical-Hospital Centre Zemun-Belgrade, Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Belgrade, Belgrade, University Clinical-Hospital Centre Zemun-Belgrade, Department of Endocrinology and Diabetes, Faculty of Medicine, University of Belgrade, Belgrade, Institute of Nuclear Sciences Vinca, Department of Radiobiology and Molecular Genetics, University of Belgrade, Belgrade, Institute of Nuclear Sciences Vinca, Department of Radiobiology and Molecular Genetics, University of Belgrade, Belgrade, Institute of Nuclear Sciences Vinca, Department of Radiobiology and Molecular Genetics, University of Belgrade, Belgrade



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