| Gastroesophageal reflux disease(GERD) is a common condition. Reflux leads to not only symptoms but also injuries to esophageal tissue which cause reflux esophagitis(RE) and some severe complications such as Barrett's esophagus(BE) and esophageal adenocarcinoma (EA). The incidences of BE and EA have seen huge increases over the past several decades, but etiology and pathogenesis of these conditions remain unclear. The roles of acid and pepsin in this disorder are well understood. Recently duodenogastroesophageal reflux(DGER) was found common for GERD patients, but it抯 exact role in pathogenesis of RE and complications, and the relationship between it and acid reflux are controversial. The mechanism of each sort of reflux were seldom studied either. In the present paper the changes of histology, epithelium barrier and permeability, epithelial cell proliferation of esophageal mucosa induced by gastroesophageal reflux and DGER were compared by clinical study and animal experiment, so as to estimate the roles of different reflux in RE and it's complications. Further, the molecular-biologic mechanism of these pathology induced by different reflux was studied through detecting expressions of cell cycle-related genes (including CyclinD1, CDK1, CDK4) and tumor suppress genes (including p53, p16 and p21) and mutation of p53 gene. 1. Simultaneously 24-hour monitoring acid and bile reflux in esophagus for reflux esophagitis The aim of this part is to investigate the incidences of esophageal bile reflux and acid reflux and the relationship between them. Using ambulatory 24-hour pH monitoring and bilirubin monitoring technique, we simultaneously assessed the changes of 24-h intraesophageal pH and bile reflux in 41 subjects (including 12 healthy subjects, 17 patients with reflux esophagitis and 12 patients after gastrectomy). The glass pH electrode and the Bilitec fiberoptic probe were passed nasally and positioned 5 cm above the proximal border of the LES. It was found the time of esophageal acid exposure for RE patients was significantly more than controls and patients after gastrectomy, but there was no difference between that for postgastrectomy patients and that for healthy controls. Total percent time of pH>8 in each group was similar and all were very low. Bile reflux (DGER), represented by total percent time of bilirubin absorbance ~ 0.14, was the greatest in postgastrectomy patients, and next in patients with RE. Both of them were significantly greater than that in controls. There was a close association between DOER and total percent time of pH<4 (r~0.75,p<0.05)but a poor relationship (r=0. 1 7)with total percent of time pH>8. Acid reflux was found in 88.2% of RE patients,and DGER in 70.6%. 64.7% of patients with RE simultaneously had acid reflux and bile reflux. It is concluded that both of gastric juice and duodenal contents reflux in esophagus are common in GERD(RE) patients, and they can occur at the same time. 2. Establishing of animal mod?of reflux esophagiti~ and tumor induced by differwt ~ and studying morphoing~al diang5 The aim of this part is to investigate the effect of different reflux agent on esophageal mucosa and esophageal tumorgenesis by establishing animal models of reflux esophagitis and esophageal tumor. Three kinds of esophageal reflux model, which were gastroesophageal reflux(G), duodenoesophageal reflux(D) and duodenogastroesophageal reflux(DO), and control group(C) were made by operations in 320 Sprague-Dawley rats.
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