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
ARTICLE HIGHLIGHTS
Research background

Laparoscopic anti-reflux surgery (LARS) is the preferred therapeutic approach for gastroesophageal reflux disease (GERD), as it effectively prevents the reflux of gastric contents into the esophagus. While there is existing knowledge about the recovery period of LARS (typically reported as 8-10 wk in the literature), limited data is available regarding the healing process within the esophageal mucosa following this procedure. This study aims to illuminate the recovery process of patients with GERD who have undergone LARS, with a specific focus on the inflammatory pathways within the esophageal mucosa.

Research motivation

Patients who have undergone LARS often report the eventual healing of symptoms such as heartburn and regurgitation after the surgery. However, a small percentage continues to experience GERD symptoms even post-LARS. The available data on LARS is primarily derived from patients’ responses.

Research objectives

We aim to focus on the inflammatory and recovery processes within the esophageal mucosa before and after the surgery.

Research methods

Twenty-two patients with GERD (the same patients before and after LARS) and 25 healthy controls (HCs) were enrolled in the study. Esophageal biopsies were homogenized, and the expressions of inflammatory and cell signaling genes were measured using real-time polymerase chain reaction. Protein levels were assessed using the multiplex enzyme-linked immunosorbent assay method.

Research results

The approximate period between pre- and post-LARS was 6 months (5.8 ± 3.8 months). We demonstrated that proinflammatory cytokines remained activated in post-LARS patients. However, we also observed a significant increase in homeostatic and anti-inflammatory cytokines in the post-LARS group compared to both pre-LARS and HCs.

Research conclusions

We conclude that the toll-like receptor signal is involved in the activation of inflammatory cytokines, while the MEK/ERK pathway is suppressed after LARS. Despite the higher levels of inflammatory cytokines, regulatory and anti-inflammatory markers were also activated in these patients. The persistence of cytokine levels suggests that recovery may not be complete even at 6 months. Patients who have undergone LARS should avoid refluxogenic foods to prevent short-term GERD symptoms.

Research perspectives

We plan a follow-up study with esophageal biopsies and 24-h multichannel intraluminal impedance-pH impedance monitoring in the long term for those patients.