8 research outputs found
Tu1411 Beneficial Effect of Long-Term Buspirone Administration on LES Function and on Esophageal Symptoms in Patients With Systemic Sclerosis
Beneficial effect of the 5-HT1A receptor agonist buspirone on esophageal dysfunction associated with systemic sclerosis: A pilot study
Background: Esophageal involvement in systemic sclerosis (SSc) carries
significant morbidity and is empirically managed with domperidone,
albeit with questionable efficacy. The oral 5-HT1A receptor agonist
buspirone may enhance esophageal peristalsis and lower esophageal
sphincter (LES) function in healthy volunteers.
Aim: We aimed to test the hypothesis that buspirone may exert a
beneficial acute effect on esophageal motor dysfunction in symptomatic
patients with SSc.
Methods: Twenty consecutive patients with SSc reporting esophageal
symptoms underwent high-resolution manometry before and 30 minutes after
administration of buspirone (10 mg). Ten other patients received
domperidone (10 mg) and served as control group. Changes in LES resting
and residual pressure, amplitude, duration, and velocity of distal
esophageal body contractions were examined.
Results: Esophageal hypomotility and hypotensive LES was found in 63%
and 67% of patients, respectively. Demographic and clinical
characteristics, including baseline manometric parameters, were
comparable between groups. Resting pressure of LES increased after
buspirone from 9.42 +/- 2.6 to 11.53 +/- 3.4 mmHg (p = 0.0002 by paired
t-test), but not after domperidone; a trend for increase of amplitude of
contractions was also observed after buspirone (p = 0.09). Comparison of
the individual changes revealed that buspirone was superior to
domperidone in enhancing LES pressure (+2.11 +/- 2.0 versus - 0.45 +/-
2.3 mmHg, p = 0.006). No significant effects of either drug were noted
on other examined parameters of esophageal function.
Conclusion: The beneficial acute effect of buspirone on impaired LES
function associated with SSc suggests a role of 5-HT1A receptor-mediated
interactions in these patients. Prospective studies to examine whether
buspirone is of long-term therapeutic value for SSc-associated
esophageal disease are warranted
Increased Expression of VEGF, COX-2, and Ki-67 in Barrett's Esophagus: Does the Length Matter?
Barrett’s esophagus (BE) is a major complication of gastroesophageal
reflux disease due to its neoplastic potential. The length of the
metaplastic epithelium has been associated with cancer risk.
Angiogenesis, inflammation, and increased cell proliferation are early
events in the malignant sequence. Vascular endothelial growth factor
(VEGF), cyclooxygenase-2 (COX-2) and Ki-67 are indirect markers of these
complex mechanisms.
To examine the expression of VEGF, COX-2 and Ki-67 in BE and investigate
whether there is an association to Barrett’s length.
Immunohistochemistry for VEGF, COX-2, and Ki-67 was performed in
well-characterized Barrett’s samples, evaluated using a qualitative
scale and compared between long (LSBE) and short (SSBE) segments.
The study population consisted of 98 patients (78 men). LSBE and SSBE
was diagnosed in 33 (33.7%) and 65 (66.3%) cases, respectively. VEGF
was expressed in vascular endothelium of all Barrett’s specimens. COX-2
and Ki-67 expression in metaplastic epithelia was strong in 81.6 and
61.2% of the samples, respectively. Ki-67 expression was significantly
stronger in LSBE (p = 0.035), whereas VEGF expression was significantly
increased in SSBE (p = 0.031). COX-2 expression was not associated with
Barrett’s length.
VEGF, COX-2, and Ki-67 were overexpressed in the majority of Barrett’s
samples. The length was inversely associated with VEGF expression and
directly associated with Ki-67 expression
Inflammatory infiltration of metaplastic epithelium and correlation to previous diagnosis of esophagitis and Barrett's length
Objective. The contact of the gastric refluxate with the lower esophagus
results in an inflammatory-mediated tissue damage. The role of
inflammation both in the development and in the advance of Barrett’s
esophagus (BE) has not been elucidated. The aim of this study was to
assess the inflammatory infiltration in metaplastic Barrett’s epithelium
and to explore the association of microscopic inflammation to healed
esophagitis and Barrett’s length. Material and methods. Inflammatory
infiltration was qualitatively evaluated in well-characterized Barrett’s
specimens. Esophagitis was healed prior to histological sampling.
Univariate comparative analysis was performed based on BE length.
Results. Ninety-eight patients (78 male, mean age 58.3 +/- 13.3 yrs)
were retrospectively studied. Thirty-three cases with long segment BE
(LSBE) (33.7%) were spotted. Inflammatory infiltration was mild,
moderate, and severe in 35 (35.7%), 54 (55.1%), and 9 (9.1%)
specimens, respectively. The samples with moderate/severe inflammatory
infiltration were obtained from patients who had more frequently been
diagnosed with esophagitis (p = 0.025). Hiatal hernia (p = 0.001),
esophagitis (p = 0.019), and previous use of antisecretory drugs (p =
0.005) were more common in LSBE. Conclusions. Inflammatory infiltration
of Barrett’s epithelium was largely moderate despite preceding healing
of erosions with PPIs. Previous diagnosis of esophagitis correlated to
the degree of inflammation. No association of inflammation to Barrett’s
length was established