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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. |