Z Gastroenterol 2006; 44 - A157
DOI: 10.1055/s-2006-943523

The role of acidic and biliary reflux in the expression of cyclooxigenase-2 (COX-2) in Barrett metaplasia

T Wittmann 1, A Rosztóczy 1, F Izbéki 1, R Róka 1, K Vadászi 1, I Németh 2, L Tiszlavicz 2, B Bod 3, L Czakó 1, J Csanádi 3, K Csefkó 3, Zs F. Kiss 3, Cs Góg 3, J Hudák 3, K Intzédy 3, M Karácsony 3, J Kiss 3, G Kurucsai 1, Gy Lázár 4, Z Lénárt 1, K Lovik 3, T Molnár 1, F Nagy 1, J Náfrádi 3, L Oczella 3, T Oláh 3, S Radics 3, L Szalay 3, K Szentpáli 4, A Szepes 1, A Tiszai 1, A Titz 3, M Varga 3, A Váry 3, J Zombori 3, J Lonovics 1
  • 11st Dept. of Medicine, University of Szeged
  • 2Department of Pathology, University of Szeged
  • 3Departments of Medicine and Pathology in City Hospitals in Baja, Békécsaba, Gyula, Hódmezővásárhely, Orosháza, Makó, Szeged, Szentes, Hungary
  • 4Department of Sugery, University of Szeged, Hungary

The increase of the COX-2 expression is known as an early step in the sequence of malignant transformations including Barrett's metaplasia and esophageal adenocarcinoma. The aim of the study was to evaluate the role of acidic and biliary reflux in the upregulation of COX-2 activity in patients with Barrett's esophagus.

Patients, methods: Sixty patients (M/F 37/23, mean age 56(26–84) years) with endoscopic evidence for Barrett's esophagus were enrolled. The standard histological evaluation of the biopsy specimens was extended by COX-2 immunohistochemistry. The staining intensity was scored between 0 and 3 by two histologists independently. Patients underwent simultaneous 24-hour pH and Bilitec monitoring.

Results: Thirteen of 60 patients had strong, 18 had moderate, 14 weak COX-2 activity. The remaining 15 patients had no COX-2 expression in their specimen. Patients with COX-2 positivity had significantly longer total length of the metaplastic mucosa (2.19cm vs. 1.11cm) than those without it. On pH monitoring the DeMeester score (28.8 vs. 12.3), the percentage of time below pH 4 at supine position (8.0% vs. 0.5%) and the number of prolonged (>5min) reflux episodes (4 vs. 1) were significantly higher in cases with positive COX-2 staining. On Bilitec monitoring the supine fraction time of OD>0.14 was significantly higher (11.9% vs. 0.5%) in patients with positive COX-2 staining. Correlation could be established with respect to the graded intensity of COX-2 staining, the severity of nocturnal acidic and biliary reflux.

Conclusion: Prolonged nocturnal acidic and biliary reflux episodes are associated with increased COX-2 expression. These results have therapeutic implications with respect to the management of Barrett's esophagus.

The study was supported by Altana Pharma Co. Hungary and RET 08/2004 research grant.