Department of Clinical Surgery, Trinity Centre for Health Sciences, St. James's Hospital and Trinity College Dublin, Dublin 8, Ireland.
Am J Surg. 2010 Feb;199(2):137-43. doi: 10.1016/j.amjsurg.2008.11.032. Epub 2009 Mar 23.
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).
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.
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.
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.
巴雷特食管腺癌序列的特征是分子变化，包括核因子-κB（NF-κB）的激活和相关细胞因子。在这项观察性非随机研究中，我们比较了接受抗反流手术或质子泵抑制剂（PPIs）治疗的无症状患者的分子环境。
对长节段巴雷特食管的无症状患者，从鳞柱状交界处下方 2cm 处取内镜活检标本，用于测量激活的 NF-κB 和一组细胞因子和生长因子。
共招募了 37 名患者（手术组：n=18，药物组：n=19）。患者平均年龄为 51 岁，平均随访时间为 5.6 年。两组患者的巴雷特食管长度、内镜和组织病理学特征均无差异。手术组激活的 NF-κB p50 和 p65 亚单位、白细胞介素（IL）-1α、IL-1β 和白细胞介素-8 水平显著降低（P<.05）。
这项研究为抗反流手术可能提供一种炎症和肿瘤发生程度低于药物治疗患者的环境这一观点提供了间接证据。
