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Existe-t-il un traitement médical de l’œsophage de Barrett?

Is there a medical treatment for Barrett’s esophagus?

  • Published:
Acta Endoscopica

Résumé

L’œsophage de Barrett est caractérisé par le remplacement de l’épithélium malpighien de l’œsophage distal par un épithélium de type glandulaire. Cette entité pathologique est causée, dans la majorité des cas, par un reflux gastro-œsophagien sévère. Le risque de développer un adénocarcinome œsophagien est multiplié par 30 à 40 chez les patients atteints de cette pathologie. A l’heure actuelle seule la recherche systématique de la dysplasie par biopsie endoscopique a une valeur prédictive certaine.

Les traitements du reflux gastro-œsophagien doivent être appliqués en fonction de l’existence ou non de symptômes et de lésions associés d’œsophagite sur lesquels les antisécrétoires modernes, notamment les inhibiteurs de pompe à protons se révèlent en règle générale, très efficaces. Bien que certains résultats préliminaires laissent entrevoir la possibilité de régression de la muqueuse de Barrett après suppression prolongée de l’agression acide, il n’existe pas de preuve définitive qu’une régression complète et durable puisse être obtenue chez la majorité des patients, ni surtout que ces traitements permettent de réduire l’incidence de la dysplasie et du cancer.

Summary

Barrett’s oesophagus is characterised by the presence in the distal gullet of a columnar epithelium. In the vast majority of patients it is the consequence of severe gastroesophageal reflux. The risk of developing an esophageal adenocarcinoma is increased by a factor of 30 to 40. Only a systematic search for dysplasia of the Barrett mucosa has predictive value. The treatment modality of the underlying gastroesophageal reflux depends upon the presence or absence of symptoms and/or lesions of reflux disease, antisecretory drugs are mostly efficacious. There are some preliminary data suggesting that regression of the Barrett mucosa can occur after prolonged protection of the esophageal mucosa against acid aggression. However, there is no evidence at present that lasting regression can be obtained in the majority of patients, nor that the incidence of dysplasia and cancer can be reduced.

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Authors and Affiliations

  1. Clinique des Maladies de l’Appareil Digestif, C.H.U. Nord, 44035, Nantes Cedex, France

    J. P. Galmiche

  2. Service de Médecine Interne et Gastroentérologie, Universitaire Ziekenhuizen, UZ. Gasthuisberg, Herestraat 49, 3000, Leuven, Belgique

    G. Vantrappen

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  1. J. P. Galmiche
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  2. G. Vantrappen
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Galmiche, J.P., Vantrappen, G. Existe-t-il un traitement médical de l’œsophage de Barrett?. Acta Endosc 23, 93–99 (1993). https://doi.org/10.1007/BF02968619

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  • DOI: https://doi.org/10.1007/BF02968619

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