Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.
J Neurogastroenterol Motil. 2013 Apr;19(2):210-8. doi: 10.5056/jnm.2013.19.2.210. Epub 2013 Apr 16.
BACKGROUND/AIMS: There has been no report regarding the regression of Barrett's esophagus (BE) by continuous treatment of proton pump inhibitor (PPI). The aim of this study was to determine the regression rate of BE by PPI and predictable markers related to regression.
Thirty-five patients diagnosed as BE were consecutively enrolled and most of them took continuous PPI. The 25 patients underwent endoscopic surveillance and received biopsy. If the specialized intestinal metaplasia (SIM) was lost at any point of surveillance and did not recur, the case was regarded as the regression group. The proportion of SIM was graded and the mucin phenotype was decided using immunohistochemistry for MUC2, MUC5AC and MUC6. To assess the cell proliferation indexes and the degree of intestinal maturation, immunohistochemistry for Ki67 and CDX2 were performed.
The regression of BE occurred in the 11 (44%) patients. The clinical and demographic factors showed no difference between the regression (n = 11) and persistence group (n = 14). The lower grade of SIM (P < 0.001) and gastric predominant mucin phenotype (P = 0.018) were more frequent, and the number of Ki67 positive cell per gland (P = 0.008) and the mean extent of CDX2 (P = 0.022) were lower in the regression group than in the persistence group.
The regression of BE by PPI treatment was frequent in Korea. The immunohistochemical detection of mucin phenotype, grade of SIM, Ki67 and CDX2 expression in Barrett's mucosa could be useful as a predictable marker for regression of SIM in BE.
背景/目的：质子泵抑制剂（PPI）连续治疗对巴雷特食管（BE）的消退尚无报道。本研究旨在确定 PPI 治疗 BE 的消退率及与消退相关的可预测标志物。
连续纳入 35 例诊断为 BE 的患者，其中大部分患者接受了连续 PPI 治疗。25 例患者接受了内镜监测并进行了活检。如果在任何监测点的特异性肠化生（SIM）消失且不复现，则认为该病例为消退组。对 SIM 的比例进行分级，并通过免疫组织化学检测 MUC2、MUC5AC 和 MUC6 决定黏蛋白表型。为了评估细胞增殖指数和肠成熟程度，进行了 Ki67 和 CDX2 的免疫组织化学检测。
11 例（44%）患者的 BE 发生了消退。消退组（n=11）和持续组（n=14）在临床和人口统计学因素方面无差异。较低的 SIM 分级（P<0.001）和胃优势黏蛋白表型（P=0.018）更常见，Ki67 阳性细胞每腺（P=0.008）和 CDX2 平均程度（P=0.022）较低。
韩国 PPI 治疗 BE 消退较为常见。在 Barrett 黏膜中检测黏蛋白表型、SIM 分级、Ki67 和 CDX2 的免疫组化表达可能有助于预测 SIM 在 BE 中的消退。
