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| Behavior Of The Oxidative Stress And Scavenger Capacity In Esophageal Mucosa After Antireflux Surgery: A Prospective Four Year Follow-up Study |
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Back to 86th Annual Meeting Back to Program Outline Objective: Oxidative stress (OS) is linked to the pathogenesis of gastroesophageal reflux disease (GERD), Barrett´s esophagus, and esophageal adenocarcinoma. We investigated whether OS can be eliminated by successful antireflux surgery (fundoplication) in the esophageal mucosa. Methods: OS of the esophageal mucosa in the proximal and distal esophagus was measured in 20 patients with objectively verified severe GERD, before fundoplication and 6 and 48 months after it, and compared with normal controls (N=9). Preoperatively, 12 of the 20 had erosive esophagitis or Barrett´s metaplasia. Postoperatively, healing of GERD was verified with endoscopy and 24-h pH monitoring. We measured OS by myeloperoxidase activity (MPA) by the method of Suzuki, superoxide dismutase activity (SOD) by the method of Laihia, and gluthatione (GSH) by Saville's method from distal and proximal esophagus samples from endoscopy. Results: No patient had reflux symptoms after fundoplication, and all 24 h pH measurements had normalized. MPA both in the distal and proximal esophagus was at baseline significantly higher than that of controls and remained significantly higher both 6 and 48 months postoperatively(p<0.05). The difference between distal and proximal esophagus samples was significant at all time point in patients(p<0.01) but not in controls. At all time-points, GSH levels in both distal and proximal esophagus were lower than control levels(p<0.01) but there were no significant difference between proximal and distal samples in patients. SOD values were significantly higher in distal than in proximal esophagus at all time points in patients but not in controls. Conclusions: OS (as reflected by MPA) to entire esophageal mucosa remains increased despite successful antireflux surgery. GERD patients seems to have deficient scavenger capacity (as shown by GSH) preoperatively and it is not normalized after successful fundoplication. According to our results it is arguable to perform fundoplication in order to prevent consequence of OS like adenocarcinoma of esophagus. Back to 86th Annual Meeting Back to Program Outline |
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