PEPSIN SECRETION, PEPSINOGEN, AND GASTRIN IN BARRETTS-ESOPHAGUS - CLINICAL AND MORPHOLOGICAL-CHARACTERISTICS

Abstract

Four cases of Barrett''s esophagus are presented. Three cases presented with significant esophageal bleeding and 1 case presented with high esophageal stricture. Gastrointestinal panendoscopy was done in each case and multiple biopsies were taken. The biopsies were utilized for histomorphology, pepsinogen agar gel electrophoresis, and tissue gastrin assays. Tissue gastrin levels in esophageal mucosa were elevated in 2 cases when compared to controls with and without hiatus hernia. Pepsin and acid secretory studies were done by isolating the esophagus. Barret''s esophagus produced pepsin by both chemical studies (2 cases), agar gel electrophoresis at pH 5.7 (3 cases) and also produced acid. The mucosa contained either cathepsin or cathepsin and pepsinogens in all cases. Nissen''s fundoplication was performed in all of the patients. Of 3 patients who were bleeding, 2 who consented for this operation stopped bleeding after the operation. The usual clinical treatment of antacids, bedrest and raising the head end of the bed failed in all of the patients. The follow-up of 9 mo. to 3 yr postoperatively has showed persistence of Barrett''s mucosa with no evidence for any reversion to normal esophageal type.