Efficacy of proton pump inhibitors for cellular proliferation and apoptosis in Barrett's oesophagus with different mucin phenotypes

Abstract

Summary

Background

Controversy exists concerning the efficacy of acid suppressants in the regression of Barrett's oesophagus.

Aim

To evaluate the effect of proton pump inhibitors on cyclooxygenase-2 expression, cellular proliferation and apoptosis in Barrett's oesophagus with different mucin phenotypes.

Methods

Four hundred and sixty-six biopsy samples of Barrett's oesophagus from 358 non-treatment patients and 81 from 61 chronic proton pump inhibitor users were immunohistochemically examined using anti-cyclooxygenase-2 protein, anti-proliferating cell nuclear antigen and anti-single stranded DNA antigens in both mucin phenotypes of Barrett's oesophagus.

Results

Prevalence of the cyclooxygenase-2 expression pattern did not significantly differ between the non-treatment and proton pump inhibitor users. In those using proton pump inhibitors, significant suppression of the proliferating cell nuclear antigen index was found in Barrett's oesophagus with the gastric-predominant mucin phenotype, but not with the intestinal-predominant mucin phenotype. Apoptosis indices in chronic proton pump inhibitor users did not significantly differ between the two mucin phenotypes.

Conclusions

Proton pump inhibitors suppress cellular proliferation in Barrett's oesophagus with the gastric-predominant mucin phenotype but not in that with the intestinal-predominant mucin phenotype. This finding may at least partly explain the ongoing controversy surrounding the notion that all cases of Barrett's oesophagus respond to acid-suppressive therapy.