Predictors for squamous re-epithelialization of Barrett's esophagus after endoscopic biopsy.
OBJECTIVE
Acid suppressive therapy has been reported to regress Barrett's esophagus. However, it is still controversial as to whether all Barrett's esophagus patients respond to this therapy. The factors that might facilitate newly developed squamous re-epithelialization after biopsy excision of Barrett's mucosa were evaluated to identity individuals who may favorably respond to the regression therapy.


METHODS
Two hundred and forty-seven biopsy sites from 185 patients with Barrett's esophagus were examined by endoscopy to investigate possible squamous re-epithelialization of Barrett's mucosa after endoscopic biopsy. Before endoscopic examination, all participants were requested to answer questionnaires concerning sociodemographic characteristics, lifestyle habits and drugs usage. The mucin phenotype, Cdx2 expression, cyclooxygenase-2 expression, cellular proliferation and apoptosis of Barrett's mucosa were immunohistochemically investigated in the biopsy samples taken from Barrett's esophagus. The influence of these factors on the newly developed squamous re-epithelialization of Barrett's mucosa after endoscopic biopsy excision was evaluated.


RESULTS
By multivariate analysis, the independent factors that favored squamous re-epithelialization were the gastric mucin predominant phenotype of Barrett's mucosa and the absence of Cdx2 protein expression. In Barrett's mucosa with the gastric predominant mucin phenotype, proton pump inhibitor administration, the absence of reflux esophagitis and a low proliferating cell nuclear antigen index were found to be independent predictors for squamous re-epithelialization.


CONCLUSIONS
The absence of the intestinal predominant mucin phenotype was a positive predictor for newly developed squamous re-epithelialization at the site of biopsy of Barrett's mucosa. Only Barrett's esophagus with the gastric predominant mucin phenotype may predict a favorable response to acid suppressive therapy.
Amano
Yuji
Y
Division of Gastrointestinal Endoscopy, Shimane University Hospital, Izumo-shi, Shimane, Japan. amano@med.shimane-u.ac.jp
Kushiyama
Yoshinori
Y
Yuki
Takafumi
T
Takahashi
Yoshiko
Y
Chinuki
Daisuke
D
Ishimura
Norihisa
N
Furuta
Kenji
K
Ishihara
Shunji
S
Adachi
Kyoichi
K
Maruyama
Riruke
R
Kinoshita
Yoshikazu
Y
D000368:Aged; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000473:pathology*; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D016009:Chi-Square Distribution; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D005752:Gastric Mucins / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D010641:Phenotype; D011237:Predictive Value of Tests; D012307:Risk Factors; D011795:Surveys and Questionnaires
D000897:Anti-Ulcer Agents; D052246:Cyclooxygenase 2 Inhibitors; D005752:Gastric Mucins