1.Reduce gastroesophageal reflux


Shaheen et al. [45] Surgical antireflux procedures are highly effective at reducing gastroesophageal reflux episodes, healing esophagitis, and decreasing the symptoms associated with reflux. It is logical, therefore, to consider their application in the setting of BE to reduce the risk of progression to cancer.

To achieve the first goal of treatment for patients with BE the therapy had not guided by symptoms. Patients should have 24-hour PH monitoring. The author Castell et al. [46] reported an evening dose of H2 receptor antagonist in addition to the twice-daily dose of PPI. Better no therapy compared with incomplete therapy. Finally, gastric PH should be PH =7 with therapy.

Second and third goals therapy are to eliminate IM, to prevent dysplasia and cancer. Despite regular therapy, this did not cause IM regression [47, 48].

Langergren et al. reported the patients who have had symptoms like heartburn and regurgitation have been at risk for adenocarcinoma of the esophagus 8-fold more compared with patients without symptoms [49].

They concluded that treatment did not prevent dysplasia. Some studies had emphasized this issue. There was no reduction in the length of BE despite therapy with 60 mg lansoprazole once a day, almost 3 years [18].

Malesci et al. have shown reducing from length from 4.5 to 2.1 cm with therapy for acid suppression [50]. These studies have demonstrated the difficulties to replicate the impressive decreased length of BE. With PPI therapy twice daily arrived total control of esophageal acid but just in a series of 9 patients. The length of BE was from 7.2 to 5.2 cm (with P < 0.0001) [5]. The use of ranitidine 150 mg twice daily compared with omeprazole 40 mg showed a minimal decrease in segment length in BE. Histamine blockers are not effective in decreasing in the length of BE compared with omeprazole [12].

The conclusion are as follow:

