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Article Type

Original Study

Abstract

Objective This study aimed to determine p53 protein expression by immunohistochemistry in the esophageal mucosa of patients with gastroesophageal reflux disease (GERD). Background GERD is a common clinical disorder that can significantly impact the patient«SQ»s quality of life and pose a significant burden on healthcare systems worldwide. The incidence of esophageal adenocarcinoma has been increasing rapidly over the past few decades. The major risk factors predisposing to the development of adenocarcinoma are long-standing GERD and Barrett«SQ»s esophagus. P53 protein expression in esophageal carcinogenesis is still being studied. The identification of tumor markers in patients with GERD may enable recognition of subgroups of patients who are more at risk of developing dysplasia and/or cancer. Patients and methods This study was carried out on 200 patients with symptoms of GERD. They were recruited from the endoscopy unit of Menoufia University Hospital between August 2010 and March 2013, and were included in group 1. According to the results of upper endoscopy and histopathology, they were subdivided as follows: group 1a included patients with GERD with erosive esophagitis ( n = 180), group 1b included patients with GERD and Barrett«SQ»s esophagus ( n = 20), and group 2 included 20 patients with other GIT symptoms with no reflux and normal esophageal squamous epithelium; this was the control group. Written valid consent was obtained from every patient for examination and upper endoscopy; the clinical sheet for every case was completed, including assessment of history, examination, and the investigations required. Results We found negative reactivity for p53 in 20 histologically normal patients (0%), and positive p53 protein expression in 76 patients (40%) in the esophagitis group and in 14 patients (70%) with Barrett«SQ»s metaplasia ( n = 20). According to the Los Angeles classification grade, p53 was overexpressed in 33.3% ( n = 24) of esophagitis grade A (mild esophagitis) patients, 46.3% ( n = 32) of esophagitis grade B (moderate esophagitis) patients, 56.4% ( n = 22) of esophagitis grade C patients, and 60% ( n = 12) of esophagitis grade D (severe esophagitis) patients. Conclusion GERD grades C and D were more prevalent in Barrett«SQ»s esophagus. P53 expression was higher in Barrett«SQ»s esophagus than in erosive esophagitis compared with the normal group. P53 protein expression increases gradually with the severity of esophagitis caused by GERD.

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