Prognostic significance of mucosal transformation factors in patients with Barrett’s esophagus

Abstract

Barrett's esophagus is an acquired pathological condition that develops as a result of the replacement of the destroyed stratified squamous epithelium of the lower part of the esophagus with a cylindrical cell epithelium, which includes goblet cells and which occurs as a result of repeated action of damaging factors on the esophageal mucosa RESEARCH OBJECTIVE, To develop an algorithm for managing patients with an established diagnosis of Barrett's esophagus before the appearance of severe dysplastic changes in the esophageal mucosa, depending on the identification of epithelial transformation factors, in order to prevent the development of the oncological process. MATERIALS AND METHODS, The work was carried out at the Moscow Medical Center for the Development of the Barrett's Disease in the period from 2013 to 2023. The study was conducted both retrospectively and prospectively. CONCLUSIONS: 1. The course of the disease and the results are different in patients belonging to the same group and having the same morphological diagnosis; 2. The presence of mild dysplasia does not affect the treatment results; the greatest success in treating patients with BP, close to the indicators in the control group, was achieved in groups ia and iia, both in total indicators for the SDTS and in the proportion of failures; 3. The lowest indicators on the GerdQ and SDTS scale and the highest proportion of failures were in group ii, which means that these patients are at risk of neoplastic transformation of the columnar epithelium; 4. Gender characteristics have a statistically significant effect on the course of the disease: in women, the treatment results are better 93% > 50 points on the SDTS compared to 84% in men (p < 0.01); 5. Age characteristics have a statistically significant effect on the course of the disease, since there is a statistically significant difference in the success rates of treatment in patients under 50 years of age (p < 0.05); 6. High results of treatment of patients by SDC> 50 points are registered in patients with absence or simultaneous growth of expression of genes p53 and p63, as well as ki-67 in the range from 20 to 40%, the obtained data are statistically reliable p<0.05; 7. The adopted algorithm of diagnostics, treatment and dynamic observation in the studied groups of patients with BP, taking into account the identified factors of neoplastic transformation of columnar epithelium, allowed to achieve high total indicators by SDC, reflecting success in achieving the set goals of treatment, 92.6% of patients had indicators> 50.