Proliferative activity in Barrett's esophagus before and after antireflux surgery

Objective To assess proliferation in the columnar-lined esophageal mucosa before and after antireflux surgery. Summary Background Data Intestinal metaplasla persists in Barrett's mucosa after reflux control. It remains at risk for uncontrolled cellular proliferation and adenocarcinoma formation. Methods Forty-five patients with Barrett's esophagus had a mean follow-up of 4 year s after a Collis-Nissen gastroplasty. Proliferative activity was assayed im munohistochemically for Ki-67 expression in 73 preoperative and 176 postope rative biopsies. Correlation with manometric and 24-hour pH results was obt ained. Results The Collis-Nissen gastroplasty restored the median lower esophageal sphinct er gradient from 5.5 mmHg before surgery to 14.5 mmHg at 24 months and 12.9 mmHg at 48 months Conclusions In Barrett's mucosa, from preoperative values, proliferation peaked early a fter surgery and then decreased to preoperative levels. Despite sphincter r estoration and global reflux control, abnormal esophageal acid exposure per sisted in 12 patients. Patients with abnormal esophageal acid exposure disp layed more proliferation and more dysplasia. after surgery. The median esop hageal acid exposure was reduced from 8% to 1% and 1% of recording time, re spectively. The median Ki-67 labeling index Increased from 28.5% before sur gery to 36.1 % at 12 to 23 months. It returned to preoperative level (26.9% ) at 24 to 47 months. After surgery, abnormal intraesophageal acid exposure was documented in 12 patients but could not be correlated with sphincter p ressure.. After surgery, the pattern of proliferation in patients with acid exposure less than 4% in their esophagus showed significant differences wh en compared with the proliferation pattern of patients where abnormal intra esophageal acid exposure was recorded. New present dysplasia was observed o nly in patients with abnormal acid exposure.