Z Gastroenterol 2005; 43 - 165
DOI: 10.1055/s-2005-869812

Prolonged combined biliary and acidic nocturnal reflux episodes develop dysplasia in patients with intestinal metaplasia of the esophagus

T Wittmann 1, A Rosztóczy 1, F Izbéki 1, G Kurucsai 1, R Róka 1, I Németh 1, L Tiszlavicz 1, B Bod 1, L Czakó 1, J Csanádi 1, Cs Góg 1, J Hudák 1, K Intzédy 1, M Karácsony 1, Gy Lázár 1, Zs Lénárt 1, K Lovik 1, T Molnár 1, F Nagy 1, L Oczella 1, T Oláh 1, S Radics 1, L Szalay 1, K Szentpáli 1, A Szepes 1, A Tiszai 1, A Titz 1, M Varga 1, A Váry 1, J Zombori 1, J Lonovics 1
  • 1First Dept. of Medicine, Dept. of Pathology, Dept. of Surgery, University of Szeged, and Depts. of Medicine and Depts. of Pathology of City Hospitals Baja, Békécscsaba, Gyula, Hódmezővásárhely, Makó, Orosháza, Szeged, Szentes.

The increasing incidence of esophageal adenocarcinoma in the western countries has prompted us to establish the South Hungarian Regional Surveillance Group for the Study of Barrett's Esophagus in 2003. In the present report we made an interim analysis of the data collected so far. The aim of the study was to evaluate the role of acidic and biliary reflux in the development of metaplastic and dysplastic mucosal changes in patients with Barrett's esophagus.

Patients, methods: Sixty-five consecutive patients (M/F 43/22, mean age 56 (26–80) years) with endoscopic evidence for Barrett's esophagus were enrolled. The histologic evaluation of the biopsy specimens included immunohistochemistry and cytometry as well. Patients underwent simultaneous 24-hour pH and Bilitec monitoring.

Results: On histology 23/65 patients had cardiac, 11/65 had fundic, 3/65 had antral, and 28/65 had intestinal type metaplasia. Low grade dysplasia was found in 15 (3 of them developing in non-intestinal type metaplasia) and high grade dysplasia in 4 subjects. Patients with intestinal type metaplasia had significantly longer cardia-diaphragm distance (2.79cm vs. 1.60cm), and total length of the metaplastic mucosa (3.80cm vs. 1.59cm) than those without. On pH monitoring the DeMeester score (60.9 vs. 29.7), the percentage of time below pH 4 during the whole 24-hour period (15.8% vs. 8.1%) and in supine position (19.2% vs. 4.2%) was significantly higher in cases with intestinal metaplasia. On Bilitec monitoring the duration of the longest biliary reflux episode (142min vs. 64min), the total (19.7% vs. 10.3%) and supine (32.8% vs. 12.6%) fraction times were significantly higher in patients with intestinal metaplasia. As regards dysplasia in patients with intestinal metaplasia only the supine fraction time below pH 4 was significantly higher out of the studied 24-hour pH and biliary monitoring parameters (28.7% vs. 6.6%).

Conclusion: Our results reveal a specific role of the long combined biliary and acidic nocturnal reflux episodes in the development of dysplasia in patients with intestinal metaplasia.

The study was supported by Altana Pharma AG., Hungary