الفهرس 
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Abstract
Gastroesophageal reflux disease is a common medical problem with
a broad spectrum of symptoms and varying degrees of severity.
(Giannini et al, 2008). The first consensus definition of GERD is known
as Montreal definition which defines the condition as “a condition which
develops when the reflux of stomach contents causes troublesome
symptoms and/or complications” (Vakil et al, 2006).
It usually manifests as heartburn, regurgitation or dysphagia and
predisposes to the development of esophagitis, stricture, barrett’s
metaplasia and esophageal adenocarcinoma, in addition to a substantial
decrease in the quality of life ( Roy and Jan, 2003).
Because of this risk, early identification of malignant changes is
very important, the Tp53 gene malfunction may precede dysplastic
changes in Barrett’s esophagus (Lope et al, 2005). p53 protein
expression in esophageal carcinogenesis is still being studied. The
identification of tumor markers in patients with GERD may allow defined
subgroups of patients more prone to develop dysplasia and/or cancer
(Younes et al, 1993).
This study was planned to detect the immunohistochemical
expression of p53 in the esophageal mucosa of patients with GERD.
The present study was conducted on two hundred patients suffering from
symptoms of gastroesophgeal reflux disease. According to the results of
upper endoscopy and histopathology, they were subdivided into :
Group (1a): patients with gastroesophgeal reflux disease with erosive
esophagitis (n=180)
Group (1b): patients with gastroesophgeal reflux disease and barrett’s
esophagus (n=20)
Group (2):
This group included 20 patient suffering from other GIT symptoms other
than GERD (dyspepsia, upper GIT bleeding, persistent vomiting,
epigastic pain) and have normal esophageal squamus epithelium, which
were taken as a control group.
They were chosen from the endoscopy unit of Menoufiya university
hospital between August 2010 and March 2013
Patients and control groups were subjected to the following :-
1-Full and detailed history taken
2- Complete clinical examination.
3- Laboratory investigations.
4- Abdominal ultrasonography.
5- Upper gastrointestinal endoscopy and biopsies were taken from
distal esophageal mucosa
6- Histopathological examination of all biopsies
7- P53 protein expression was determined by immunohistochemical
studies
The results of the study were tabulated, statistically analyzed and
graphically represented.
The present study revealed the following results:
There was non significant difference between the studied groups
as regard age
There was non significant difference between the studied groups
as regard the gender although barrett’s group more common in
male than female
The prevalence of BE was 10% in patients with GERD and reflux
esophagitis.
There was non significant difference between the studied groups
as regard smoking and alcohol intake .
There was non significant difference between the studied groups
as regard GERD symptoms (heart burn, regurgitation, eructation ,
epigastric pain, dyspepsia, dysphagia, weight loss, upper GIT
bleeding, vomiting).
There was non significant difference between the studied groups
as regard the laboratory findings
Among the patients with erosive esophagitis, grade A erosions
were established in 70 patients (38.8%), grade B in 65 patients
(36.1%), grade C in 33 patients (18.3%) and grade D in 12 patients
(6.7%). All the patients with Barrett’s esophagus also had erosive
esophagitis
There was significant difference between the studied groups as
regard hiatus hernia, hiatus hernia more prevalent in patients with
barrett’s esophagus
There was significant difference between the studied groups as
regard gastritis, gastritis more prevalent in control group
There was significant difference between the studied groups as
regard P53 immunohistochemestry. p53 expression was significantly higher in barrett’s esophagus than in erosive
esophagitis and not detected in normal group.
P53 activity in GERD patients according to Los Angeles
classification (P53 expression was significantly higher in
esophagitis grade D and C than in esophagitis grade B and A
patients and normal control.
There was a clear correlation between the degree of esophagitis
severity and p53 expression.
Conclusion: from the present study, we concluded the following:
GERD grade C and D were more prevalent in barrett’s esophagus
p53 expression was higher in barrett’s esophagus than in erosive
esophagitis than in normal group.
p53 protein expression increased gradually with the severity of
esophagitis caused by GERD.