The Evaluation of Oesophageal Function in Patients with Different Types of Oesophageal Metaplasia

Abstract

Aim: To evaluate the oesophageal function in patients with different types of oesophageal metaplasia and in cases with dysplasia on the basis of the Montreal definition of gastro-oesophageal reflux disease. Patients and Methods: 270 consecutive patients [M/F 151/119, mean age 54.2 years (19–84)] with endoscopic and histological evidence of oesophageal metaplasia were prospectively studied: patients with specialized intestinal metaplasia (SIM, n = 109) and patients without SIM (n = 161). Patients with SIM were subdivided into a dysplasia-positive (n = 34) and a dysplasia-negative (n = 75) group. All patients underwent reflux symptom analysis, oesophageal manometry, and simultaneous 24-hour pH and biliary reflux monitoring. Results: Patients with SIM were significantly older and had a significantly higher body mass index than patients without SIM. A significant male predominance was observed in patients with SIM and dysplasia compared to the dysplasia-negative group. The clinical symptom spectrum and the prevalence of erosive oesophageal lesions were similar in all groups. Patients with SIM had longer metaplastic segments, which was further increased in the dysplasia-positive group. During oesophageal manometry, pH and biliary reflux monitoring, patients with SIM had more severe alterations than patients without SIM, and these were further increased in patients with SIM and dysplasia. Conclusions: Patients with SIM had more severe oesophageal function abnormalities than those with other types of oesophageal metaplasia (e.g. gastric). The oesophageal function was further impaired if dysplasia was present in the metaplastic mucosa.

Role of ion transporters in the bile acid-induced esophageal injury

“…esophagus; epithelium; bile acids; ion transporters BARRETT'S ESOPHAGUS (BE) is a premalignant condition of esophageal adenocarcinoma, characterized by the replacement of the normal squamous epithelium (SE) with a columnar, specialized intestinal type mucosa (50). It is considered to be the most severe complication of gastro-esophageal reflux disease (GERD) (7,20), in which the prolonged, long-term, repetitive episodes of combined acidic and biliary reflux are thought to induce the development of a metaplastic mucosal lining in the esophagus (44). By definition, esophageal columnar metaplasia is present if then columnar lining can be observed above the esophagogastric junction (top of the gastric folds or distal end of esophageal palisade veins) during endoscopy.…”

“…Several studies have established the harmful effects of both gastric and bile acids on the esophageal mucosa (13,40,41,47,58,63). Since they were also shown to promote cell differentiation and proliferation, their role in the development of columnar metaplasia and later esophageal adenocarcinoma is widely accepted (10,14,22,24,30,44,45). However, the underlying mechanism by which metaplastic columnar epithelium then dysplasia and finally invasive cancer develops is not completely understood yet.…”

Multimodal Evaluation of Esophageal Epithelial Response in Gastroesophageal Reflux Disease

“…Gastric acid is considered to be the most important contributing factor to GERD related symptoms and complications. Its pathogenic role is supported by the fact that GERD patients experience significantly increased acidic reflux (21) and acid supressing therapy has brought relief to GERD patients. (22) …”