Apoptosis in Barrett's oesophagus following antireflux surgery.
BACKGROUND
Intestinal metaplasia persists in Barrett's mucosa despite control of reflux. Tissue homeostasis is maintained by the balance between apoptosis and proliferation. There is an unexplained temporary increase in proliferation in patients with Barrett's mucosa after antireflux surgery, and the long-term effect of any therapy in altering this balance remains unclear. The aim of this study was to assess apoptosis in Barrett's oesophagus following antireflux surgery.


METHODS
Apoptosis was evaluated in endoscopic biopsy specimens from 19 patients with Barrett's oesophagus 4 years after Collis-Nissen gastroplasty using an in situ terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labelling (TUNEL) method.


RESULTS
Intestinal metaplasia had a lower apoptosis index than gastric metaplasia (0.27 versus 2.14 per cent; P < 0.001). After operation there was a steady increase of apoptosis in intestinal metaplasia over time (from 0.23 per cent before operation to 0.42 per cent within 2 years and to 0.59 per cent 4 years after operation; P = 0.015). Patients with persistent acid exposure did not show any increase in apoptosis in comparison with patients without acid exposure (0.41 versus 0.59 per cent; P = 0.91).


CONCLUSIONS
Apoptosis is less in intestinal metaplasia than in gastric metaplasia, although there is an increase after antireflux surgery. Persistent acid reflux may predispose to malignancy.
Chen
L Q
LQ
Department of Surgery, Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
Hu
C Y
CY
Der Sarkissian
S
S
Ferraro
P
P
Pera
M
M
deBlois
D
D
Gaboury
L
L
Duranceau
A C
AC
D017209:Apoptosis; D001471:Barrett Esophagus / Q000473:pathology* / Q000601:surgery; D001706:Biopsy / Q000379:methods; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal; D004945:Esophagoscopy; D005764:Gastroesophageal Reflux / Q000473:pathology / Q000601:surgery*; D006801:Humans; D020287:In Situ Nick-End Labeling / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa