Gastroenterology Unit, Department of Internal Medicine, University of Pisa, Italy.
Aliment Pharmacol Ther. 2011 May;33(9):1019-27. doi: 10.1111/j.1365-2036.2011.04616.x. Epub 2011 Mar 8.
Barrett's oesophagus is regarded as the most important risk factor for development of oesophageal adenocarcinoma. According to current guidelines, treatment should be limited to symptomatic Barrett's oesophagus.
To evaluate the expression of Ki67, cyclooxygenase-2 (COX-2) and apoptosis in Barrett's oesophagus after 12 months of double-dose proton pump inhibitor therapy. The effectiveness of esomeprazole and pantoprazole was also compared.
Seventy-seven nondysplastic Barrett's oesophagus patients underwent baseline upper endoscopy. Patients were then randomised into two groups: one group was allocated to receive esomeprazole 40 mg b.d. and the other group pantoprazole 40 mg b.d. for 12 months. A follow-up endoscopy was performed at the end of treatment. Sixty-five of 77 patients agreed to undergo oesophageal manometry and 24-h pH-metry. Barrett's oesophagus biopsies, obtained at baseline and after treatment, were analysed using immunohistochemistry to assess Ki67 and COX-2 expression; apoptosis was evaluated using TUNEL.
In the esomeprazole group, a significant decrease in Ki67 and COX-2 expression, as well as an increase in apoptosis, were observed (P < 0.05). By contrast, in the pantoprazole group Ki67, COX-2 and apoptosis did not vary significantly from baseline. By 24-h oesophageal pH-monitoring, a normal acid exposure time was recorded in patients treated with esomeprazole, while those allocated to pantoprazole displayed abnormal acid exposure (P < 0.05).
Treatment of Barrett's oesophagus patients with high-dose esomeprazole, but not pantoprazole, promoted a decrease in proliferative markers, concomitantly with a decrease in apoptotic cell death. Moreover, esomeprazole allowed a better oesophageal acid control than pantoprazole.
巴雷特食管被认为是食管腺癌发展的最重要危险因素。根据目前的指南，治疗应仅限于有症状的巴雷特食管。
评估双倍剂量质子泵抑制剂治疗 12 个月后巴雷特食管中 Ki67、环氧化酶-2（COX-2）和细胞凋亡的表达。还比较了埃索美拉唑和泮托拉唑的疗效。
77 例非异型增生性巴雷特食管患者接受基线上消化道内镜检查。然后将患者随机分为两组：一组接受埃索美拉唑 40mg，每日两次；另一组接受泮托拉唑 40mg，每日两次，治疗 12 个月。治疗结束时进行随访内镜检查。77 例患者中有 65 例同意接受食管测压和 24 小时 pH 监测。使用免疫组织化学分析基线和治疗后获得的巴雷特食管活检标本，评估 Ki67 和 COX-2 表达；通过 TUNEL 评估细胞凋亡。
在埃索美拉唑组中，Ki67 和 COX-2 表达显著下降，细胞凋亡增加（P<0.05）。相比之下，泮托拉唑组中 Ki67、COX-2 和细胞凋亡与基线相比无显著变化。通过 24 小时食管 pH 监测，接受埃索美拉唑治疗的患者酸暴露时间正常，而接受泮托拉唑治疗的患者酸暴露异常（P<0.05）。
高剂量埃索美拉唑治疗巴雷特食管患者可降低增殖标志物水平，同时降低细胞凋亡。此外，埃索美拉唑比泮托拉唑能更好地控制食管酸。
