W1093 Long-Term Consequences of Acid Suppression With Esomeprazole and Laparoscopic Antireflux Surgery on Esophageal Squamous Epithelium Morphology: Lessons From the Lotus Study

Abstract

G A A b st ra ct s gastritis according to the Sydney classification, and the oxyntic endocrine cell population according to Solcia et al. Results: Mucosal inflammation and activity improved over 5 yrs in the antrum of Hp+ patients randomized to ESO (p<.0001), whereas other changes in inflammation and activity (antrum and corpus) or between ESO and LARS, were not (or barely) significant. Neither intestinal metaplasia nor atrophy developed in the oxyntic mucosa during the 5 yrs of ESO therapy. Oxyntic ECL cell hyperplasia (diffuse, linear or micronodular) occurred in 4.1% of ESO cases at baseline, and in 9.9%, 10.0%, and 13.9% at 1, 3, and 5 yrs respectively (p<.001). It corresponded to a rapid, but stable increase in mean gastrin levels from 65.6pg/mL at baseline to 164.4pg/mL after 5 yrs. The corresponding mean chromogranin A levels were 81.2 and 216.3ng/mL, respectively. By contrast, there was an apparent decrease in ECL cell proliferation after LARS (from 8.7% at baseline to 2.5% at 5 yrs) although this change was not significant (p=.21). Conclusions: Long-term esomeprazole therapy (5 yrs) is followed by improvement in antral inflammation and a continued proliferative drive on ECL cells of the oxyntic gland mucosa, as reflected by the development of hyperplastic changes. No dysplastic or neoplastic lesions were detected. The apparent decrease in ECL cells in the LARS group may have been due to discontinuation of previous PPI therapy.