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Barrett’s oesophagus and oesophageal adenocarcinoma: how does acid interfere with cell proliferation and differentiation?
  1. R C Fitzgerald
  1. Correspondence to:
    Dr R C Fitzgerald
    Cancer Cell Unit, Hutchison-MRC Research Centre, Cambridge CB2 2XZ, UK; rcfhutchison-mrc.cam.ac.uk

Abstract

Acid, a principal component of gastro-oesophageal refluxate, may contribute to the development and malignant progression of Barrett’s oesophagus. Oesophageal pH monitoring studies have demonstrated that patients with Barrett’s oesophagus have severe and chronic acid reflux. However, there is overlap between the amount of acid exposure in patients with oesophagitis compared with patients with Barrett’s oesophagus. This suggests that factors other than acid may be important in the aberrant oesophageal cell differentiation process that leads to the development of the metaplastic Barrett’s mucosa. The other factors important in the aetiology of Barrett’s oesophagus are poorly understood but probably include both genetic and environmental factors.

  • COX-2, cyclo-oxygenase 2
  • MAPK, mitogen activated protein kinase
  • PCNA, proliferating cell nuclear antigen
  • PKC, protein kinase C
  • PPI, proton pump inhibitor
  • PGE2, prostaglandin
  • Barrett’s oesophagus
  • oesophageal adenocarcinoma

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Footnotes

  • Rebecca Fitzgerald is funded by the Medical Research Council.

  • Conflicts of interest: The author has given occasional talks for the manufacturers of PPIs and COX-2 inhibitors.

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