Gastroesophageal reflux disease (GERD) is a major public health problem that may
cause erosive or nonerosive esophagitis in symptomatic patients. The severity
of esophagitis in GERD seems to be correlated not only to the amount of reflux
and altered motor activity but also to the ability of the mucosa to resist injury and repair
the damage. This study aimed to evaluate the cell proliferation status of esophageal
epithelium in both normal individuals and patients with GERD with or without erosions
and its correlation with the degree of inflammation of the esophagus.
Participants and methods
This study was carried out on 33 individuals; their ages ranged between 17 and 74
years. All participants were subjected to a clinical assessment and an endoscopic
evaluation. Four biopsies were taken using an endoscope at 5 cm from the Z-line;
histological esophagitis was identified and graded. Cell proliferation was evaluated
by Ki-67 immunostaining.
The prevalence of GERD was the highest in the 15–29 years age group (46.43%) and
decreased with age. Cell proliferation [estimated by the Ki-67-labeling index (Ki-67 LI)]
was reduced in esophageal epithelium in erosive (13.44%) and nonerosive (36.83%)
reflux disease in relation to normal individuals (68%). There was a statistically
significant positive correlation between cell proliferation (Ki-67 LI) and the endoscopic
grade of esophagitis among patients with erosive disease. However, there was no
significant correlation between cell proliferation (Ki-67 LI) and the histological grade
of esophagitis in both erosive and nonerosive reflux disease.
The ability of the mucosa to resist injury and to repair the damage should be
considered a key factor in the development of GERD. Esophageal mucosa exposed to
chronic acid insult show reduced cell replication, estimated by the Ki-67 LI. Erosive
esophagitis in GERD seems to be related to a low cell proliferation rate of esophageal
epithelium rather than the amount of reflux.