Dynamic effects of acid on Barrett's esophagus. An ex vivo proliferation and differentiation model

J Clin Invest. 1996 Nov 1;98(9):2120-8. doi: 10.1172/JCI119018.


Barrett's esophagus (BE), or specialized intestinal metaplasia, is a premalignant heterogeneous epithelium associated with reflux and an increased risk for adenocarcinoma. Since acid is a major component of refluxate, we investigated its effects ex vivo on cell differentiation as determined by villin expression; and on cell proliferation, as determined by tritiated thymidine incorporation and proliferating cell nuclear antigen expression. To mimic known physiological conditions, endoscopic biopsies of normal esophagus, BE, and duodenum were exposed, in organ culture, to acidified media (pH 3-5) either continuously, or as a 1-h pulse and compared with exposure to pH 7.4 for up to 24 h. Before culture, villin expression was noted in 25% of BE samples, and increased after 6 or 24 h of continuous acid to 50% or 83% of BE samples, respectively. Increased villin expression correlated with ultrastructural maturation of the brush border. In contrast, an acid-pulse followed by culture at pH 7.4, did not alter villin expression in BE. Moreover, continuous acid exposure blocked cell proliferation in BE, whereas, an acid-pulse enhanced cell proliferation, as compared to pH 7.4. Based on our ex vivo findings, we propose a model in which the diverse patterns of acid exposure in vivo may contribute to the observed heterogeneity and unpredictable progression to neoplasia of BE.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Barrett Esophagus / pathology*
  • Biopsy
  • Carrier Proteins / metabolism
  • Cell Differentiation
  • Cell Division
  • Cell Survival / drug effects
  • Duodenum / metabolism
  • Duodenum / pathology
  • Esophagus / metabolism
  • Esophagus / pathology
  • Humans
  • Hydrochloric Acid / metabolism
  • Hydrochloric Acid / pharmacology*
  • Hydrogen-Ion Concentration
  • Microfilament Proteins / metabolism
  • Microvilli / metabolism
  • Organ Culture Techniques
  • Proliferating Cell Nuclear Antigen / metabolism
  • Time Factors


  • Carrier Proteins
  • Microfilament Proteins
  • Proliferating Cell Nuclear Antigen
  • villin
  • Hydrochloric Acid