Treatment of non-erosive reflux disease and dynamics of the esophageal microbiome: a prospective multicenter study

Abstract

Non-erosive reflux disease (NERD) pathogenesis has not been thoroughly evaluated. Here, we assessed the response of patients with NERD to proton pump inhibitor (PPI) therapy; changes in the microbiome and biologic marker expression in the esophageal mucosa were also evaluated. Patients with NERD (n = 55) received esomeprazole (20 mg) for eight weeks. The treatment response was evaluated at baseline, week four, and week eight. Esophageal mucosal markers and oropharyngeal and esophageal microbiomes were analyzed in patients who underwent upper gastrointestinal endoscopy at screening (n = 18). Complete and partial response rates at week eight were 60.0% and 32.7% for heartburn, and 61.8% and 29.1% for regurgitation, respectively. The expressions of several inflammatory cytokines, including IL-6, IL-8, and NF-κB, were decreased at week eight. Streptococcus, Haemophilus, Prevotella, Veillonella, Neisseria, and Granulicatella were prevalent regardless of the time-point (baseline vs. week eight) and organ (oropharynx vs. esophagus). The overall composition of oropharyngeal and esophageal microbiomes showed significant difference (P = 0.004), which disappeared after PPI therapy. In conclusion, half-dose PPI therapy for eight weeks could effectively control NERD symptoms. The expression of several inflammatory cytokines was reduced in the esophagus, and oropharyngeal and esophageal microbiomes in patients with NERD showed significant difference. However, the microbial compositions in the oropharynx and esophagus were not affected by PPI therapy in this study. Impact of PPI on the microbiome in patients with NERD should be more investigated in future studies.

Randomized Controlled Trial Comparing the Efficacy of Sustained-Release Formula of Mosapride-Plus-Esomeprazole Combination Therapy to Esomeprazole Monotherapy in Patients with Gastroesophageal Reflux Disease

“…In a previous study using esomeprazole in patients with GERD, the complete-response rate was 60.0% for heartburn and 61.8% for regurgitation after an eight-week treatment [ 25 ], whereas in this study, it was only 33.3% for total GERD symptoms based on the RDQ scores. The relatively lower response rate might be explained by the difference in the heterogeneity of the baseline clinicodemographic background, such as a higher proportion of patients with mild GERD symptoms and those with NERD, the difference in the questionnaire used for GERD symptoms, and the difference in dosage used for esomeprazole (40 mg vs. 20 mg).…”

Impact of endoscopic submucosal dissection and epithelial cell sheet engraftment on systemic cytokine dynamics in patients with oesophageal cancer

“…Another factor that potentially influenced the circulating cytokine levels was the medication, particularly the proton pump inhibitors (PPIs). PPIs reduced the inflammatory cytokines in patients with non-erosive reflux disease 19 . Although no previous reports have investigated the effect of PPIs in patients who have undergone oesophageal ESD, all the patients in our study were treated with PPIs after ESD.…”

Multi-omics reveals microbiome, host gene expression, and immune landscape in gastric carcinogenesis

“…Notably, HP eradication therapy in patients with HP infection has been associated with partial restoration of normal microbial diversity ( Guo et al., 2020 ). The abundant bacterial taxa in patients who received HP eradication, including Veillonellaceae, Micrococcaceae, and Streptococcaceae, may originate from the oral cavity ( Park et al., 2020 ). In addition, our observation that intragastric microbial diversity is different across disease states is consistent with the findings of previous studies ( Aviles-Jimenez et al., 2014 ; Ferreira et al., 2018 ; Gantuya et al., 2020 ; Hsieh et al., 2018 ; Wang et al., 2020 ).…”