Effects of Long-term Treatment with Proton Pump Inhibitors in Gastro-oesophageal Reflux Disease on the Histological Findings in the Lower Oesophagus

Stolte, Manfred; Schmitz, James M.; Alexandridis, T.; Seifert, E

doi:10.1080/003655200750056574

Cited by 34 publications

(5 citation statements)

References 18 publications

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Section: Discussionsupporting

confidence: 90%

“…Although earlier studies suggested increased frequency and severity of basal cell hyperplasia in patients with gastroesophageal reflux (1,15), more recent studies have not demonstrated a significant difference in basal zone hyperplasia between controls and patients with reflux (2,3,16,17). The frequency of basal cell hyperplasia in pediatric patients with gastroesophageal reflux and erosive esophagitis in this study closely matches the findings of prior studies in adults (18) studies have also suggested a relationship between eosinophils and basal cell hyperplasia. Four of 6 children, less than 2 years of age, with isolated eosinophils in the esophageal epithelium had increased basal cell thickness, and there was a significant linear correlation between the number of esophageal epithelial eosinophils and the percentage of basal cell thickness (19).…”

Section: Discussionsupporting

confidence: 82%

See 1 more Smart Citation

Severity of Basal Cell Hyperplasia Differs in Reflux Versus Eosinophilic Esophagitis

Steiner

Kernek

Fitzgerald

2006

J. pediatr. gastroenterol. nutr.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 82%

Severity of Basal Cell Hyperplasia Differs in Reflux Versus Eosinophilic Esophagitis

Steiner

Kernek

Fitzgerald

2006

J. pediatr. gastroenterol. nutr.

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“…These variables have not previously been studied in the most distal squamous epithelium of long-segment BE patients. We observed only a marginal effect of therapy in the direction towards normalization, but obviously these changes are different from what has been demonstrated to occur in response to PPI therapy in the distal esophagus of GERD patients[31]. It might be argued that baseline data were captured after a too limited period of time for duodeno-gastro-esophageal reflux to exert its full damaging effect.…”

Section: Discussioncontrasting

confidence: 88%

Impact of gastroesophageal reflux control through tailored proton pump inhibition therapy or fundoplication in patients with Barrett’s esophagus

Baldaque‐Silva¹,

Debel²,

Håkanson³

et al. 2017

WJG

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AIMTo determine the impact of upwards titration of proton pump inhibition (PPI) on acid reflux, symptom scores and histology, compared to clinically successful fundoplication.METHODSTwo cohorts of long-segment Barrett’s esophagus (BE) patients were studied. In group 1 (n = 24), increasing doses of PPI were administered in 8-wk intervals until acid reflux normalization. At each assessment, ambulatory 24 h pH recording, endoscopy with biopsies and symptom scoring (by a gastroesophageal reflux disease health related quality of life questionnaire, GERD/HRLQ) were performed. Group 2 (n = 30) consisted of patients with a previous fundoplication.RESULTSIn group 1, acid reflux normalized in 23 of 24 patients, resulting in improved GERD/HRQL scores (P = 0.001), which were most pronounced after the starting dose of PPI (P < 0.001). PPI treatment reached the same level of GERD/HRQL scores as after a clinically successful fundoplication (P = 0.5). Normalization of acid reflux in both groups was associated with reduction in papillary length, basal cell layer thickness, intercellular space dilatation, and acute and chronic inflammation of squamous epithelium.CONCLUSIONThis study shows that acid reflux and symptom scores co-vary throughout PPI increments in long-segment BE patients, especially after the first dose of PPI, reaching the same level as after a successful fundoplication. Minor changes were found among GERD markers at the morphological level.

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“…Hyperemia of the capillaries presents as papillary elongation. 20 Infiltration of lymphocytes appears to be more frequent than infiltration with eosinophilic or neutrophilic granulocytes. 21 A previous study showed significant histopathological differences between NERD and functional heartburn.…”

Section: Discussionmentioning

confidence: 99%

Prospective Single Arm Study on the Effect of Ilaprazole in Patients with Heartburn but No Reflux Esophagitis

et al. 2018

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PurposePatients with gastroesophageal reflux disease without esophagitis show varying responses to proton pump inhibitors (PPIs). The aim of this study was to objectively evaluate the effect of a new PPI, ilaprazole, on patients with heartburn but without reflux esophagitis.Materials and MethodsThis prospective study was performed on 20 patients with heartburn but without reflux esophagitis. All patients underwent upper endoscopy and 24-hr combined multichannel intraluminal impedance and pH esophageal monitoring (MII-pH). They were then treated with ilaprazole (20 mg) once daily for 4 weeks. The GerdQ questionnaire, histologic findings, and inflammatory biomarkers were used for assessment before and after ilaprazole.ResultsAmong the 20 patients, 13 (65%) showed GerdQ score ≥8. Based on MII-pH results, patients were classified as true nonerosive reflux disease (n=2), hypersensitive esophagus (n=10), and functional heartburn (n=8). After treatment, patients showed a statistically significant improvement in GerdQ score (p<0.001). Among histopathologic findings, basal cell hyperplasia, papillary elongation, and infiltration of intraepithelial T lymphocytes improved significantly (p=0.008, p=0.021, and p=0.008; respectively). Expression of TNF-α, IL-8, TRPV1, and MCP-1 decreased marginally after treatment (p=0.049, p=0.046, p=0.045, and p=0.042; respectively).ConclusionDaily ilaprazole (20 mg) is efficacious in improving symptom scores, histopathologic findings, and inflammatory biomarkers in patients with heartburn but no reflux esophagitis.

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Effects of Long-term Treatment with Proton Pump Inhibitors in Gastro-oesophageal Reflux Disease on the Histological Findings in the Lower Oesophagus

Abstract: Our study shows not only that erosions and ulcers heal under PPI treatment, but also that hyperplasia of the basal cell layer and elongation of papillae in the squamous epithelium of the oesophageal mucosa may normalize, and are thus presumably not 'normal physiological variants'.

Cited by 34 publications

References 18 publications

Severity of Basal Cell Hyperplasia Differs in Reflux Versus Eosinophilic Esophagitis

Severity of Basal Cell Hyperplasia Differs in Reflux Versus Eosinophilic Esophagitis

Impact of gastroesophageal reflux control through tailored proton pump inhibition therapy or fundoplication in patients with Barrett’s esophagus

Prospective Single Arm Study on the Effect of Ilaprazole in Patients with Heartburn but No Reflux Esophagitis

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