Introduction

To compare real‐world outcomes of radiofrequency ablation (RFA) for Barrett’s esophagus (BE) in Belgium before (Feb 2008–Jan 2017) and after (Jan 2017–Dec 2023) reimbursement, focusing on efficacy (complete remission of intestinal metaplasia, CR-IM; complete remission of dysplasia, CR-D), safety, baseline histology, and prior endoscopic resection (ER) rates, with statistical testing.

Aims & Methods

Prospective registry of expert Belgian centers.
- Pre-reimbursement: 342 treated, 295 evaluable (≥ 1 y follow-up; ITT efficacy).
- Post-reimbursement: 701 treated, 627 evaluable (≥ 1 y follow-up; ITT efficacy).
Patients in 2024–2025 with < 5 sessions and no CR were censored. Collected: demographics, histology (IM, LGD, HGIN, EAC), ER rate, Prague C/M, RFA sessions, and outcomes. Categorical variables by χ²/Fisher’s exact; continuous by Mann–Whitney U test.

Results

Conclusion

After reimbursement, Belgian centers treated more patients with no statistically significant differences in demographics, baseline histology, BE extent, ER practice, efficacy or safety (all p>0.05). Reimbursement broadened access without compromising RFA outcomes. Continuous surveillance remains essential.​​​​

References

Vliebergh JH, Deprez PH, de Looze D, Ferrante M, Orlent H, Macken E, Christiaens P, Mana F, De Hertogh G, Willekens H, Bisschops R. Efficacy and safety of radiofrequency ablation of Barrett’s esophagus in the absence of reimbursement: a multicenter prospective Belgian registry. Endoscopy. 2019 Apr;51(4):317–325. doi:10.1055/a-0739-7679. Epub 2018 Oct 25

Disclosure

Speaker fee for Medtronic

Clinical Case Summary

A 54-year-old male with no significant past medical history presented with a five-year history of chronic gastrointestinal and systemic symptoms. He was initially diagnosed with irritable bowel syndrome (IBS) based on recurrent postprandial bloating, periumbilical abdominal discomfort, alternating diarrhea and constipation, and a persistent sensation of gastric fullness independent of food intake. Despite comprehensive management and a low-FODMAP diet, he reported minimal to no clinical improvement.
In addition to gastrointestinal complaints, the patient described recurrent headaches and chronic fatigue, both temporally associated with the consumption of histamine-rich foods such as red wine, aged cheeses, and processed meats. The neurological evaluation was unremarkable. Laboratory investigations were within normal limits, including complete blood count, inflammatory markers, liver and renal function tests, and celiac serologies. Gastroscopy and colonoscopy excluded structural, neoplastic, and inflammatory gastrointestinal pathology. However, serum diamine oxidase (DAO) activity was significantly decreased (2.8 U/mL; reference >10 U/mL), suggesting histamine intolerance secondary to DAO deficiency as the underlying etiology.
Therapeutic intervention included a strict low-histamine diet, oral DAO supplementation, and intermittent use of H1-antihistamines for symptomatic exacerbations. At a three-month follow-up, the patient reported substantial improvement in gastrointestinal and systemic symptoms, including normalizing bowel habits, resolution of headaches, and alleviating fatigue and bloating.
This case underscores the importance of considering histamine intolerance in patients with persistent IBS-like symptoms, particularly when conventional therapeutic strategies fail and symptom patterns suggest dietary histamine sensitivity. DAO activity testing may aid in diagnosis and guide effective, targeted therapy.

Disclosure

No Conflict of Interest.