GERD May Be Caused By Inflammation Not Acid, Study Says

First Posted: May 25, 2016 06:40 AM EDT

A new study reveals that Gastroesophageal Reflux Disease (GERD) is caused by an immune reaction rather than the direct chemical injury from stomach acids.

Medscape reports that the study was printed online in JAMA on May 17, 2016. The study was led by Kerry Dunbar, MD, Ph.D., from the Dallas Veterans Affairs Medical Center in Texas, the first author of the study and other scholars.

The researchers explained that in this preliminary study of 12 patients with acute reflux esophagitis successfully treated with PPI therapy, stopping PPI medication was linked with T lymphocyte-predominant esophageal inflammation and basal cell and papillary hyperplasia without loss of surface cells. They added that if replicated, these findings imply that the pathogenesis of reflux esophagitis may be cytokine-mediated instead of the result of a chemical injury.

The study involved 12 patients with severe reflux esophagitis successfully treated with PPIs. They were told by the researchers to stop taking their PPIs and received evaluations at baseline. The assessments include esophagoscopy 24-hour esophageal pH and impedance monitoring. They biopsied the non-eroded areas of the esophagus in which the immune activity was assumed to be lower than the eroded areas.

The participants (11/12) had no visible evidence of esophagitis at baseline. After stopping PPIs in 2 weeks, all the participants had esophagitis and five of them had severe esophagitis.

When the participants stopped PPIs within 2 weeks, they developed abnormalities characteristic of GERD. The biopsies also showed increased in the infiltration of intraepithelial lymphocytes 1 and 2 weeks after stopping PPIs. The researchers said that esophageal basal cell and papillary hyperplasia have developed in areas without surface erosions. They added that if the traditional notion were true that acute GERD is triggered by refluxed acid directly inflicting lethal, chemical injury to surface epithelial cells, then papillary hyperplasia and the basal cell would have been expected only in areas with surface erosions and the permeating inflammatory cells would have been granulocytes primarily. They also noted that further studies are needed to guarantee the results.

GERD affects millions of people all around the globe. It is a digestive order that affects the lower esophageal sphincter (LES) and the ring of muscle between the stomach and the esophagus. Its reflux is the return of the stomach's contents that move backward into the esophagus. It can be treated with medication or surgery. In most cases, it can be relieved through lifestyle and diet changes.


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