Reflux induced apoptosis of the esophageal mucosa is inhibited in Barrett's epithelium

BACKGROUND: Apoptosis maintains cell homeostasis. Altered apoptosis is invo lved in carcinogenesis. It was our aim to investigate whether reflux esopha gitis may alter apoptosis in the esophageal mucosa and whether antireflux s urgery may restore normal apoptosis. METHODS: Apoptosis was studied preoper atively and postoperatively in esophageal biopsies of 39 patients with vari ous grades of reflux esophagitis and in Barrett's mucosa using the TUNEL me thod. Biopsies were also taken from lesions of the squamous epithelium adja cent to the Barrett's mucosa. RESULTS: Apoptosis increased with the severit y of esophagitis. Apoptosis was low in Barrett's epithelium. Squamous epith elium adjacent to Barrett's mucosa showed increased apoptosis. After surger y apoptosis decreased in squamous epithelium, and it remained low in Barret t's epithelium. CONCLUSIONS: Apoptosis in reflux esophagitis may be protect ive against increased proliferation. Low apoptosis following antireflux sur gery indicates that surgery is effective to prevent reflux-induced cell pro liferation. Inhibition of apoptosis in Barrett's may promote carcinogenesis . This may not change following surgery. Am J Surg. 1998;176:569-573. (C) 1 998 by Excerpta Medica, Inc.