الفهرس 
• AcknowledgementsOnly 14 pages are availabe for public view
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Abstract
GERD is a chronic disease caused by regurgitation of acid from the stomach into the esophagus. Heartburn and acid regurgitation are the cardinal symptoms of GERD. It represents a major public health problem with 10–20% of adults experiencing reflux symptoms.
The relation between the morphological appearance and the severity of GERD seems to be correlated not only to the amount of reflux and altered motor activity but also to the capacity of the mucosa to resist to injury and repair the damage. So, esophageal cell proliferation should be taken in consideration as one of the factors implicated in the heterogeneous panorama of GERD. Moreover, several phenomena like NERD cannot be fully explained on the basis of failure of anti-reflux mechanisms.
Ki-67 is a nuclear protein that is used as a marker of cell proliferation in many tissues, and the percentage of immunopositive cells represents a reliable proliferation index usually referred to as the Ki-67 labeling index (Ki67-LI).
Our study aims to evaluate the cell proliferation status of esophageal epithelium in both healthy normal subjects and patients with gastroesophageal reflux symptoms with or without erosions, and to detect the correlation between esophageal cell proliferation and degree of esophagitis both endoscopic and histological.
This study was conducted on 33 subjects, their ages ranged between 17 to 74 years. After signing a written consent, all subjects were submitted to clinical assessment; endoscopic evaluation to assess the presence or absence of erosions and to identify the grade of esophagitis according to the Los Angeles (LA) classification system. Four biopsies were taken via endoscope at 5 cm from the Z-line; histological esophagitis was identified and graded according to the Ismail-Beigi et al. classification and cell proliferation was evaluated by Ki-67 immunostaining.
Subjects in this study were divided into 3 groups:
• Group1: 16 patients with gastroesophageal reflux symptoms with erosions (ERD), 7 males.
• Group2: 12 patients with gastroesophageal reflux symptoms without erosions (NERD), 4 males.
• Group3: 5 healthy controls, 4 males.
The results of the present study revealed that prevalence of GERD was highest in the 15-29 years age group (46.43%) and decreased with age being lowest in the ≥ 60 years age group (14.29%). Neither of the studied special habits nor sex were risk factors for GERD.
Ki67-LI is reduced in esophageal mucosa exposed to chronic acid insult. In particular patients with GERD have a decrease in Ki-67 immunostaining to 36.833% and 13.438% in NERD and ERD, respectively, compared to normal subjects (68%).
There is a strong correlation between cell proliferation (Ki67-LI) and the LA classification grade of esophagitis among ERD patients. The Ki67-LI tended to increase with disease severity, being highest in grade D (18.5%) and lowest in grade A (10.89%).
There is no correlation between cell proliferation (Ki67-LI) and the histological grade of esophagitis among both ERD and NERD patients.