Oxidative stress to esophageal mucosa plays a key role in the pathogenesis of gastroesophageal reflux disease (GERD), Barrett's esophagus, and adenocarcinoma.
Dr Jarmo Salo and colleagues from Finland investigated whether successful antireflux surgery eliminates oxidative stress.
Oxidative stress of esophageal mucosa was measured in 20 GERD patients, before antireflux surgery and 6 and 48 months after it.
The investigative team then compared the results with normal controls' mucosa.
Preoperatively, 12 of the 20 had erosive esophagitis or Barrett's metaplasia.
Postoperatively, healing of GERD was verified with endoscopy and 24-hour pH monitoring.
|Myeloperoxidase activity was higher with preoperatively detected erosive reflux disease|
|American Journal of Gastroenterology|
The investigators measured oxidative stress by myeloperoxidase activity, and superoxide dismutase activity.
The investigators also assessed glutathione content in distal esophagus samples from endoscopy.
No patient had reflux symptoms after surgery, and pH measurements had normalized.
The investigative team noted that myeloperoxidase activity in the distal esophagus decreased after successful antireflux surgery.
However, the team noted that it remained higher than that of controls both 6 months and 4 years postoperatively.
At all time-points, myeloperoxidase activity was higher in patients with preoperatively detected erosive reflux disease vs non-erosive reflux disease.
Glutathione content values decreased with time only in non-erosive reflux.
At all time-points, the team observed that glutathione content levels in distal esophagus were lower than control levels.
Dr Salo's team concludes, “Antireflux surgery can heal macroscopic esophagitis but cannot fully reverse the oxidative stress, as reflected by myeloperoxidase activity and glutathione content, upon the distal esophageal mucosa.”