2002 Fiscal Year Final Research Report Summary
EFFECT OF ANTI-REFLUX SURGERY OR ACID SUPPRESSION THERAPY ON ESOPHAGEAL AND GASTRIC MUCOSA IN PATIENTS WITH REFLUX ESOPHAGITIS
| Project/Area Number |
12671266
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Digestive surgery
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| Research Institution | JIKEI UNIVERSITY SCHOOL OF MEDICINE |
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Principal Investigator |
KASHIWAGI Hideyuki JIKEI UNIVERSITY SCHOOL OF MEDICINE, 医学部, 助教授 (40185757)
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| Co-Investigator(Kenkyū-buntansha) |
HAGIWARA Eiitirou JIKEI UNIVERSITY SCHOOL OF MEDICINE,DEPARTMENT OF SURGERY,ASSISTANT, 医学部, 助手 (30287271)
ISHIBASI Yosio JIKEI UNIVERSITY SCHOOL OF MEDICINE,DEPARTMENT OF MEDICINE,LECTURER, 医学部, 助手 (00246373)
OMURA Nobuo JIKEI UNIVERSITY SCHOOL OF MEDICINEDEPARTMENT OF SURGERY, ASOCIATE PROFESSOR, 医学部, 講師 (70271301)
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| Project Period (FY) |
2000 – 2002
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| Keywords | REFLUX ESOPHAGITIS / GASTROESOPHAGEAL REFLUX DISEASE / LAPAROSCOPIC ANTIREFLUX SURGERY / PROTON PUMP INHIBITORS / GASTRIN / GASTRIN CELL / ECL CELL / PARIETAL CELL |
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| Research Abstract |
AIMS: We investigated the effects of laparoscopic antireflux surgery or proton pump inhibitor on esophageal and gastric mucosa in patients with reflux esophagitis.
Patients and Methods: In a prospective study, we assessed 20 patients of laparoscopic fundophcations for reflux esophagitis (surgical group) and 11 patients of maintenance therapy with proton pump inhibitors (PPI group). Clinical findings, endoscopic findings, serum gastrin levels, gastnc endocrine cells (G-cell ECL cell), and ultrastructures of parietal cell were evaluated before and after the treatments.
Results: Heartburn and regurgitation disappeared in all patients after laparoscopic fundoplication, but 2 patients had mild postoperative dyspnagia. Proton pump inhibitors significantly improved clinical symptom^ during the treatment but 2 patients(18.2%) had a relapse of heartburn. In the surgical group, 18 patients (90%) had a hiatal hernia, which was repaired after the operation. Reflux esophagitis has improved in 20 patients (100%) of the surgical group and 9 patients (81.8%) of the PPI group. Serum gastrin levels were significantly increased in the PPI group, which were unchanged in the surgical group. Maintenance therapy with PPI had a tendency to increase G-cells and ECL-cells, but not significantly .Any serious changes of the ultrastructure of parietal cell were not found in both groups but vacuole decrease of tubuolvesicles and increase of basal infolding were found in a few patients with PPI therapy.
Conclusion: PPI maintenance therapy is an excellent treatment as effective as laparoscopic fundophcation. But acid suppression has introduced elevation of serum gastrin levels, and has a tendency to increase of G-cell and ECL cell. PPI therapy is safe and effective but long-term follow up is needed about gastric endocrine behavior during the treatment
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