Differential molecular changes in patients with asymptomatic long-segment Barrett's esophagus treated by antireflux surgery or medical therapy.
BACKGROUND
The Barrett's to adenocarcinoma sequence is characterized by molecular changes including activation of nuclear factor-kappaB (NF-kappaB) and related cytokines. In this observational nonrandomized study this molecular environment was compared in matched asymptomatic cohorts who had undergone either fundoplication or therapy with proton pump inhibitors (PPIs).


METHODS
Asymptomatic patients with long-segment Barrett's esophagus had endoscopic biopsy specimens taken from 2 cm below the squamocolumnar junction for measurement of activated NF-kappaB and a panel of cytokines and growth factors.


RESULTS
Thirty-seven patients were recruited (surgical: n = 18, medical: n = 19). The mean patient age was 51 years, and the mean follow-up period was 5.6 years. There were no differences in the length of Barrett's segment and endoscopic and histopathologic features in both groups. Mean activated NF-kappaB p50 and p65 subunits, interleukin (IL)-1alpha, IL-1beta, and interleukin-8 levels, were significantly (P < .05) lower in the surgically treated group.


CONCLUSIONS
This study provides proxy support to the thesis that antireflux surgery may provide an environment that is less inflammatory and tumorigenic than that observed in medically treated patients.
Babar
Mawash
M
Department of Clinical Surgery, Trinity Centre for Health Sciences, St. James's Hospital and Trinity College Dublin, Dublin 8, Ireland.
Ennis
Darren
D
Abdel-Latif
Mohamed
M
Byrne
Patrick J
PJ
Ravi
Narayanasamy
N
Reynolds
John V
JV
D000230:Adenocarcinoma / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D016207:Cytokines / Q000378:metabolism; D004938:Esophageal Neoplasms / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D016328:NF-kappa B / Q000378:metabolism*; D018384:Oxidative Stress; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
D014408:Biomarkers, Tumor; D016207:Cytokines; D016328:NF-kappa B; D054328:Proton Pump Inhibitors