Barrett's oesophagus and reflux oesophagitis : efficacy of medical vs surgical management

胃食道反流病是非常常见的疾病。在一些人中，它会导致食道癌，食道癌的发病率增长速度比发达国家的任何其他癌症都要快。它的诊断、监测和治疗需要大量资源。有两种主要的治疗形式，抑酸药物，可能需要在人的余生，或手术。治疗的目标是控制胃灼热等症状，预防癌症。确定症状是否得到控制相对容易，内科和外科治疗都能做到这一点。衡量一种疗法是否会降低患癌症的风险并不容易，因为它需要很长时间才能发展起来。我们将比较一组接受药物治疗的反流病患者和一组接受手术治疗的患者。在每一组中，我们将在治疗前取食道组织，并将其与治疗后取的类似组织进行比较。我们将寻找病变组织中异常细胞和基因的减少，这些细胞和基因在癌症的发展中起着重要作用。这项研究将帮助我们了解反流导致食道损伤的机制，以及它是如何最终导致癌症的。我们将了解在治愈食道潜在损伤方面，内科治疗和外科治疗哪个更好，以及哪种治疗更有可能防止癌症的发展。它可能会在我们的社区中更有效地管理反流，并有助于减少食道癌的病例数量。

Gastro-oesophageal reflux disease is very common. In some people it leads to oesophageal cancer, which is increasing in incidence more rapidly than any other cancer in the developed world. Significant resources are required for its diagnosis, surveillance and treatment. There are two main forms of treatment, acid suppressing drugs which may be required for the rest of the person's life, or surgery. The goal of treatment is the control of the symptoms such as heartburn, and the prevention of cancer. It is relatively easy to determine if the symptoms are controlled, and both medical and surgical treatments do this. It is not as easy to measure if a treatment will reduce the risk of cancer, because it takes so long to develop. We will compare a group of patients with reflux disease treated with drugs with a group treated by surgery. In each group we will take oesophageal tissue before treatment and compare it with similar tissue taken after treatment. We will look for reductions in abnormal cells and genes that are in diseased tissue and are important in the development of cancer. This study will help us understand the mechanisms by which reflux causes damage to the oesophagus and how it ultimately leads to cancer. We will learn if medical or surgical treatment is better in healing the underlying damage in the oesophagus, and which treatment is more likely to prevent cancer developing. It may result in more effective management of reflux in our community and help reduce the number of cases of oesophageal cancer.