Basic Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 871-881
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.871
Inflammatory responses in esophageal mucosa before and after laparoscopic antireflux surgery
Pelin Ergun, Sezgi Kipcak, Nur Selvi Gunel, Eser Yildirim Sozmen, Serhat Bor
Pelin Ergun, Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Pelin Ergun, Sezgi Kipcak, Serhat Bor, Division of Gastroenterology, Ege University, Faculty of Medicine, Ege Reflux Group, Izmir 35100, Turkiye
Sezgi Kipcak, Nur Selvi Gunel, Department of Medical Biology, Ege University, Faculty of Medicine, Izmir 35100, Turkiye
Eser Yildirim Sozmen, Department of Medical Biochemistry, Ege University, Faculty of Medicine, Izmir 35100, Turkiye
Author contributions: Ergun P, Yildirim Sozmen E, and Bor S contributed to the conceptualization, writing-review and editing; Ergun P and Bor S were involved in the investigation; Ergun P, Kipcak S, Selvi Gunel N, Yildirim Sozmen E, and Bor S participated in the methodology and project administration; Ergun P, Kipcak S, Selvi Gunel N, and Yildirim Sozmen E contributed to the software; Ergun P was involved in the writing-original draft; and all authors have read and agreed to the published version of the manuscript.
Supported by the Scientific and Technological Research Council of Turkiye/TUBİTAK, No. 118S260; and Turkish Society of Gastroenterology, No. 797-TGD-2021.
Institutional review board statement: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Ege University, Izmir, Turkiye (18-2.1/36, 20/02/2018).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pelin Ergun, PhD, Postdoctoral Fellow, Department of Otolaryngology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States. pelinergun@yahoo.com
Received: December 5, 2023
Peer-review started: December 5, 2023
First decision: January 4, 2024
Revised: January 12, 2024
Accepted: February 28, 2024
Article in press: February 28, 2024
Published online: March 27, 2024
Abstract
BACKGROUND

Currently, the primary treatment for gastroesophageal reflux is acid suppression with proton pump inhibitors, but they are not a cure, and some patients don’t respond well or refuse long-term use. Therefore, alternative therapies are needed to understand the disease and develop better treatments. Laparoscopic anti-reflux surgery (LARS) can resolve symptoms of these patients and plays a significant role in evaluating esophageal healing after preventing harmful effects. Successful LARS improves typical gastroesophageal reflux symptoms in most patients, mainly by reducing the exposure time to gastric contents in the esophagus. Amelioration of the inflammatory response and a recovery response in the esophageal epithelium is expected following the cessation of the noxious attack.

AIM

To explore the role of inflammatory biomolecules in LARS and assess the time required for esophageal epithelial recovery.

METHODS

Of 22 patients with LARS (pre- and post/5.8 ± 3.8 months after LARS) and 25 healthy controls (HCs) were included. All subjects underwent 24-h multichannel intraluminal impedance-pH monitoring and upper gastrointestinal endoscopy, during which esophageal biopsy samples were collected using endoscopic techniques. Inflammatory molecules in esophageal biopsies were investigated by reverse transcription-polymerase chain reaction and multiplex-enzyme-linked immunosorbent assay.

RESULTS

Post-LARS samples showed significant increases in proinflammatory cytokines [interleukin (IL)-1β, interferon-γ, C-X-C chemokine ligand 2 (CXCL2)], anti-inflammatory cytokines [CC chemokine ligand (CCL) 11, CCL13, CCL17, CCL26, CCL1, CCL7, CCL8, CCL24, IL-4, IL-10], and homeostatic cytokines (CCL27, CCL20, CCL19, CCL23, CCL25, CXCL12, migration inhibitory factor) compared to both HCs and pre-LARS samples. CCL17 and CCL21 levels were higher in pre-LARS than in HCs (P < 0.05). The mRNA expression levels of AKT1, fibroblast growth factor 2, HRAS, and mitogen-activated protein kinase 4 were significantly decreased post-LARS vs pre-LARS. CCL2 and epidermal growth factor gene levels were significantly increased in the pre-LARS compared to the HCs (P < 0.05).

CONCLUSION

The presence of proinflammatory proteins post-LARS suggests ongoing inflammation in the epithelium. Elevated homeostatic cytokine levels indicate cell balance is maintained for about 6 months after LARS. The anti-inflammatory response post-LARS shows suppression of inflammatory damage and ongoing postoperative recovery.

Keywords: Anti-reflux surgery, Gastroesophageal reflux disease, Cytokine, Inflammatory response, Esophagus

Core Tip: Even six months after laparoscopic anti-reflux surgery, specific pro-inflammatory cytokines continue to exhibit activity. Elevated levels of anti-inflammatory and regulatory cytokines suggest their involvement in preserving cellular homeostasis and regulating inflammation. As a precaution, we recommend that patients who have undergone laparoscopic anti-reflux surgery avoid refluxogenic foods to prevent short-term gastroesophageal reflux disease symptoms.