Issues

Hypergastrinemia has been associated with high-grade dysplasia and adenocarcinoma in patients with Barrett's esophagus, and experimental studies suggest proinflammatory and proneoplastic effects of gastrin on Barrett's esophagus. This is of potential concern, as patients with Barrett's esophagus are treated with medications that suppress gastric acid production, resulting in increased physiologic levels of gastrin. However, in a randomized placebo-controlled controlled trial in patients with Barrett's esophagus (beginning on page 675), Abrams and colleagues showed that treatment with netazepide, a gastrin/CCK₂ receptor antagonist, had no significant impact on cellular proliferation, the primary study outcome. The cover shows a Barrett's esophagus biopsy immunostained for Ki67 (brown) and pan-cytokeratin (red), with artificial intelligence algorithms used to identify Ki67-positive epithelial nuclei (400× magnification).