Alimentary TractCyclooxygenase 2 expression in Barrett's esophagus and adenocarcinoma: Ex vivo induction by bile salts and acid exposure☆,☆☆
Section snippets
Patient population
We studied endoscopic (mucosal) biopsy specimens obtained from 46 patients with BE or esophageal adenocarcinoma who underwent upper endoscopy and biopsies as part of routine dysplasia surveillance or evaluation of upper gastrointestinal symptoms. The study was conducted at the Palo Alto Veterans Affairs Health Care System and Stanford University Hospital under a protocol that was approved by the Medical Committee for the Protection of Human Subjects. All patients had originally been referred
Clinical data
The study included the following groups of patients: (1) 30 patients, 28 men and 2 women aged 38–83 years (mean age, 63), who were found on endoscopy to have BE, all of the intestinal metaplasia type without dysplasia; (2) 11 patients, all men aged 45–79 years (mean age, 65), who were found to have BE with dysplasia; and (3) 5 patients, all men aged 50–76 years (mean age, 58), who were found on endoscopy to have esophageal adenocarcinoma involving the distal esophagus without endoscopically
Discussion
Our study evaluates the role of COX-2 in various stages of Barrett's esophageal metaplasia and shows a progressive increase in expression of this enzyme with disease progression from Barrett's metaplasia to dysplasia and adenocarcinoma. Our data indicate that COX-2 is constitutively expressed in normal esophageal and duodenal epithelia and is overexpressed as an early event in the esophageal neoplastic transformation process of Barrett's columnar metaplasia (i.e., in the absence of dysplasia).
Acknowledgements
The authors thank the Gastroenterology staff, fellows, and nurses at the Palo Alto VA Health Care System for their assistance in the collection of tissue samples, and Kris Morrow for figure preparation.
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Supported in part by the Stanford Cancer Council (to G.T.), Cancer Research Foundation of America (to B.S.K.), Veterans Administration Career Development and Merit Awards (to M.B.O.), and Digestive Disease Center grant DK 38707.
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Address requests for reprints to: George Triadafilopoulos, M.D., Gastroenterology Section, Palo Alto VA Health Care System (111-GI), 3801 Miranda Avenue, Palo Alto, California 94304. e-mail: [email protected]; fax: (650) 856-8024.