Inflammation a likely culprit in GERD-related esophagitis

Inflammation a likely culprit in GERD-related esophagitisMay 18 2016. A preliminary communication published on May 17, 2016 in the Journal of the American Medical Associationimplicates an inflammatory reaction triggered by the presence of stomach acid in the esophagus, rather than burns caused by the acid itself, as the damaging factor in patients with gastrointestinal reflux disease (GERD). 

"Although this radical change in the concept of how acid reflux damages the esophagus of GERD patients will not change our approach to its treatment with acid-suppressing medications in the near future, it could have substantial long-term implications," remarked senior author Dr Stuart Spechler, who is a professor at the University of Texas Southwestern Medical Center and a physician at the VA Medical Center.

The current study included 12 patients being treated for GERD with proton pump inhibitors (PPIs) who were asked to discontinue their medication. Participants underwent esophageal biopsies at the beginning of the study and one and two weeks after stopping the drugs. 

At one and two weeks, biopsies showed signs of T-lymphocyte-predominant inflammation. All subjects had evidence of esophageal acid exposure and esophagitis at two weeks, which is consistent with the time needed for damage caused by inflammation to develop. "These findings suggest that the pathogenesis of reflux esophagitis may be cytokine-mediated rather than the result of chemical injury," the authors conclude.

"A chemical burn should develop immediately, as it does if you spill battery acid on your hand," Dr Spechler noted.

Co-senior author Dr Rhonda Souza predicted that "Someday we might treat GERD with medications that target the cytokines or inflammatory cells that really cause the damage to the esophagus."

"We think that it is important for physicians to have an accurate understanding of the mechanisms underlying the diseases that we treat, especially one as common as GERD," Dr Spechler added.