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Histology of symptomatic gastroesophageal reflux disease: Is it predictive of response to proton pump inhibitors?
Author(s) -
Miwa Hiroto,
Takubo Kaiyo,
Shimatani Tomohiko,
Furuta Takahisa,
Oshima Tadayuki,
Tanaka Junji,
Aida Junko,
Ito Masanori,
Kurosawa Susumu,
Joh Takashi,
Wada Tsuneya,
Habu Yasuki,
Watanabe Yusuke,
Hongo Michio,
Chiba Tsutomu,
Kinoshita Yoshikazu
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.2012.07266.x
Subject(s) - nerd , histopathology , medicine , heartburn , gastroenterology , reflux , esophagitis , gerd , proton pump inhibitor , rabeprazole , reflux esophagitis , pathology , disease
Background and Aim To examine the differences in esophageal histopathology between non‐erosive reflux disease ( NERD ) and reflux esophagitis ( RE ), and to investigate whether baseline esophageal histopathology can predict the therapeutic response to proton pump inhibitors ( PPI s). Method The subjects comprised 94 patients with NERD ( n = 71) or mild RE ( n = 23). Tissue was biopsied from 5 cm above the squamo‐columnar junction (SCJ), and the degree or presence of nine histopathological markers was assessed. The patients were treated with rabeprazole ( RPZ ) 10 mg once daily for 4 weeks. If complete heartburn relief was not achieved, RPZ was increased to 10 mg twice daily for another 2 weeks, and then to 20 mg twice daily for another 2 weeks if heartburn remained. Results Features of esophageal histopathology 5 cm above the SCJ differed between NERD and RE patients. The esophageal histopathology in patients unresponsive to RPZ was characterized by Protein Gene Product ( PGP ) 9.5 negativity in those with NERD , and intraepithelial bleeding in those with RE . In addition, the combination of dilated intercellular spaces ( DIS ) (+)/ PGP 9.5 (−) was indicative of strong resistance to PPI therapy in NERD patients. Conclusion The therapeutic efficacy of PPI can be predicted from the features of biopsied esophageal tissue. Factors predictive of resistance to treatment with PPI are negativity for PGP 9.5 in NERD patients and intraepithelial bleeding in RE patients.