title: Proliferative and anti-apoptotic activity of esophageal mucosa in gastroesophageal reflux disease is not affected by fundoplication: a 4-year follow-up study.
abstract: BACKGROUND
  The role of fundoplication in the prevention of esophageal adenocarcinoma is controversial. Development of cancer is associated with proliferation and anti-apoptosis, for which little data exist regarding their response to fundoplication.
  
  
  METHODS
  Ki-67 and Bcl-2 expression was assessed in the esophagogastric junction (EGJ) and the distal and proximal esophagus of 20 patients with gastroesophageal reflux disease (GERD) treated by fundoplication and in 7 controls. Endoscopy was performed preoperatively and 6 (20 patients) and 48 months (16 patients) postoperatively.
  
  
  RESULTS
  There were positive correlations between Ki-67 and Bcl-2 levels in the EGJ (p > 0.001) and in the distal (p = 0.001) and proximal esophagus (p = 0.013). Compared to the preoperative level, Ki-67 expression was elevated in the distal (p = 0.012) and proximal (p = 0.007) esophagus at 48 months. In addition, compared to control values, Ki-67 expression was lower at the 6-month follow-up in the EGJ (p = 0.037) and the proximal esophagus (p = 0.003), and higher at the 48-month follow-up in the distal esophagus (p = 0.002). Compared to control values, Bcl-2 was lower at 6 months in the EGJ (p = 0.038).
  
  
  CONCLUSIONS
  Proliferative activity after fundoplication increased in the long term in the distal esophagus despite a normal fundic wrap and healing of GERD.
authors.affiliation: Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland.
authors.forename: T K
authors.initials: TK
authors.lastname: Rantanen
authors.forename: N K
authors.initials: NK
authors.lastname: Oksala
authors.forename: T T
authors.initials: TT
authors.lastname: Honkanen
authors.forename: J V
authors.initials: JV
authors.lastname: Räsänen
authors.forename: E I
authors.initials: EI
authors.lastname: Sihvo
authors.forename: J J
authors.initials: JJ
authors.lastname: Mattila
authors.forename: H M
authors.initials: HM
authors.lastname: Paimela
authors.forename: T K
authors.initials: TK
authors.lastname: Paavonen
authors.forename: J A
authors.initials: JA
authors.lastname: Salo
mesh_terms: D000230:Adenocarcinoma / Q000517:prevention & control; D000328:Adult; D000368:Aged; D017209:Apoptosis; D001471:Barrett Esophagus / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D015415:Biomarkers / Q000378:metabolism; D049109:Cell Proliferation; D004938:Esophageal Neoplasms / Q000517:prevention & control; D004947:Esophagus / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000378:metabolism / Q000473:pathology; D011446:Prospective Studies; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000378:metabolism; D013997:Time Factors
chemical_list: D015415:Biomarkers; D019394:Ki-67 Antigen; D019253:Proto-Oncogene Proteins c-bcl-2