Amano Yuji, Kushiyama Yoshinori, Yuki Takafumi, Takahashi Yoshiko, Chinuki Daisuke, Ishimura Norihisa, Furuta Kenji, Ishihara Shunji, Adachi Kyoichi, Maruyama Riruke, Kinoshita Yoshikazu
Division of Gastrointestinal Endoscopy, Shimane University Hospital, Izumo-shi, Shimane, Japan.
J Gastroenterol Hepatol. 2007 Jun;22(6):901-7. doi: 10.1111/j.1440-1746.2006.04369.x.
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.
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.
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.
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.
据报道，抑酸疗法可使巴雷特食管消退。然而，对于所有巴雷特食管患者是否都对该疗法有反应仍存在争议。本研究评估了可能促进巴雷特黏膜活检切除后新发生鳞状上皮再上皮化的因素，以确定可能对消退疗法有良好反应的个体。
对185例巴雷特食管患者的247个活检部位进行内镜检查，以研究内镜活检后巴雷特黏膜可能的鳞状上皮再上皮化情况。在内镜检查前，要求所有参与者回答有关社会人口学特征、生活习惯和药物使用情况的问卷。对取自巴雷特食管的活检样本进行免疫组织化学研究，检测巴雷特黏膜的黏蛋白表型、Cdx2表达、环氧化酶-2表达、细胞增殖和凋亡情况。评估这些因素对内镜活检切除后巴雷特黏膜新发生鳞状上皮再上皮化的影响。
多因素分析显示，有利于鳞状上皮再上皮化的独立因素是巴雷特黏膜的胃黏蛋白为主型表型和Cdx2蛋白表达缺失。在具有胃为主型黏蛋白表型的巴雷特黏膜中，质子泵抑制剂的使用、无反流性食管炎以及低增殖细胞核抗原指数是鳞状上皮再上皮化的独立预测因素。
肠道为主型黏蛋白表型的缺失是巴雷特黏膜活检部位新发生鳞状上皮再上皮化的阳性预测指标。只有具有胃为主型黏蛋白表型的巴雷特食管可能预示对抑酸疗法有良好反应。
