Does antireflux surgery prevent progression of Barrett's esophagus?

Mechanistic reasoning suggests that since antireflux surgery treats the gastroesophageal reflux that is the major known risk factor for Barrett's esophagus, it should have a beneficial effect on the biology of Barrett's disease. Due to a lack of adequate data, whether this is the case remains uncertain. Most studies, including several large population-based cohort studies, are observational studies that are subject to bias. Selection bias could be present, for example, if the patients undergoing one treatment had worse disease than those undergoing the comparator treatment, which seems possible for antireflux surgery and acid suppression medication therapy. A systematic review also suggests publication bias. The published data indicate that surgeons should not claim that antireflux surgery prevents the progression of Barrett's. Well-conducted prospective studies with postoperative pH studies suggest, however, that effective surgery may reduce the risk of Barrett's progression whereas ineffective surgery provides no benefit.