But when it comes to Barrett’s esophagus, a condition commonly found in people with GERD, acid control may be less important than beating back another bodily fluid – bile.
A new study published in the Annals of Surgery shows that bile – a digestive fluid that leaks backwards from the stomach into the esophagus along with acid in patients with GERD – plays a critical and previously unrecognized role in the development of Barrett’s esophagus. Study authors say the findings provide new avenues for the prevention and treatment of the condition, which is the only known cause of a rare but often deadly type of cancer called esophageal adenocarcinoma.
“Our ultimate goal is to understand the biology of Barrett’s so that we may find drugs that inhibit or reverse the condition, thus preventing cancer,” said lead study author Jeffrey H. Peters, M.D., an internationally recognized expert in surgery of the esophagus and stomach and the Seymour I. Schwartz Professor and Chair of the Department of Surgery at the University of Rochester Medical Center. “The finding that bile is important is key because current drug therapies for GERD focus largely on acid control.”
Acid-reducing drugs called proton pump inhibitors or PPIs are some of the most popular and best-selling drugs in America according to IMS Health, an organization that tracks pharmacy data. While the drugs do a great job of masking GERD symptoms by neutralizing stomach acid, Peters’ research suggests they may not be the answer when it comes to blocking Barrett’s esophagus. Other research even indicates that such drugs may actually make patients more prone to developing Barrett’s.
Normally, our esophagus – the muscular tube connecting the mouth to the stomach – is lined with skin-like tissue. But, in people with Barrett’s, it’s replaced by tissue that more closely resembles the lining of our intestine, which is smooth and red. Peters’ team found that bile that washes up from the stomach into the esophagus shuts off genes responsible for the normal, skin-like lining of the organ, and turns on genes that produce the intestine-like lining that is the hallmark of Barrett’s.
They discovered that acid, on the other hand, didn’t largely influence the change from one cell type to another.
While previous research established that reflux components encouraged the development of intestinal tissue in the esophagus that alone was never enough to produce the changes that led to Barrett’s.
“The main leap this study makes is that normal esophageal cell growth must be turned off and intestinal cell growth must be turned on in order for the disease to take hold,” noted Peters, who is president elect of the International Society of Diseases of the Esophagus. “We found that bile promotes both processes.”
Study author Tony E. Godfrey, Ph.D., says the findings make perfectly good sense. “In people with Barrett’s, the inside of the esophagus looks like the inside of the intestine. Bile is normally found in the intestinal environment, so when stem cells in the esophagus are exposed to bile that is what they change to.”
According to Godfrey, a research associate professor in the Department of Surgery, the lining of the esophagus is shed and replaced on a regular basis, so blocking bile’s ability to thwart the production of normal esophageal cells may be one potential treatment strategy. Currently, the only way to stop all reflux components, including bile, is to surgically reconstruct the faulty barrier between the esophagus and the stomach.
The team performed the first-ever analysis of all genes that are turned on and off in normal esophageal cells exposed chronically to bile or acid. The findings were tested and confirmed in human samples of normal esophageal cells and in cells from patients with Barrett’s esophagus.
The research is especially exciting for Peters, who regularly treats patients with Barrett’s as well as patients who develop esophageal adenocarcinoma. Though uncommon, Peters says it’s one of the fastest-rising cancers in the world, likely due to the increase in obesity, which triggers reflux disease and Barrett’s. Unfortunately, it is an extremely aggressive cancer that is usually caught at a very late stage, so prevention strategies are greatly needed.
The Department of Surgery at the Medical Center funded the study. In addition to Peters – who serves as the associate editor of the Annals of Surgery – and Godfrey, Marie Reveiller, Ph.D., Sayak Ghatak, Liana Toia, Mary D’Souza, Ph.D., Zhongren Zhou, M.D., Ph.D., and Santhoshi Bandla, Ph.D., from the University of Rochester contributed to the research. Scientists from the Ontario Institute for Cancer Research in Toronto and the Pittsburgh Cancer Institute at the University of Pittsburgh also participated in the study.For Media Inquiries:
Emily Boynton | EurekAlert!
Indications of Psychosis Appear in Cortical Folding
26.04.2018 | Universität Basel
GLUT5 fluorescent probe fingerprints cancer cells
20.04.2018 | Michigan Technological University
Magnetic resonance imaging, or MRI, is a widely used medical tool for taking pictures of the insides of our body. One way to make MRI scans easier to read is...
At the Hannover Messe 2018, the Bundesanstalt für Materialforschung und-prüfung (BAM) will show how, in the future, astronauts could produce their own tools or spare parts in zero gravity using 3D printing. This will reduce, weight and transport costs for space missions. Visitors can experience the innovative additive manufacturing process live at the fair.
Powder-based additive manufacturing in zero gravity is the name of the project in which a component is produced by applying metallic powder layers and then...
Physicists at the Laboratory for Attosecond Physics, which is jointly run by Ludwig-Maximilians-Universität and the Max Planck Institute of Quantum Optics, have developed a high-power laser system that generates ultrashort pulses of light covering a large share of the mid-infrared spectrum. The researchers envisage a wide range of applications for the technology – in the early diagnosis of cancer, for instance.
Molecules are the building blocks of life. Like all other organisms, we are made of them. They control our biorhythm, and they can also reflect our state of...
University of Connecticut researchers have created a biodegradable composite made of silk fibers that can be used to repair broken load-bearing bones without the complications sometimes presented by other materials.
Repairing major load-bearing bones such as those in the leg can be a long and uncomfortable process.
Study published in the journal ACS Applied Materials & Interfaces is the outcome of an international effort that included teams from Dresden and Berlin in Germany, and the US.
Scientists at the Helmholtz-Zentrum Dresden-Rossendorf (HZDR) together with colleagues from the Helmholtz-Zentrum Berlin (HZB) and the University of Virginia...
13.04.2018 | Event News
12.04.2018 | Event News
09.04.2018 | Event News
26.04.2018 | Power and Electrical Engineering
26.04.2018 | Life Sciences
26.04.2018 | Power and Electrical Engineering