Histology of symptomatic gastroesophageal reflux disease: Is it predictive of response to proton pump inhibitors?

Hiroto Miwa, Kaiyo Takubo, Tomohiko Shimatani, Takahisa Furuta, Tadayuki Oshima, Junji Tanaka, Junko Aida, Masanori Ito, Susumu Kurosawa, Takashi Joh, Tsuneya Wada, Yasuki Habu, Yusuke Watanabe, Michio Hongo, Tsutomu Chiba, Yoshikazu Kinoshita, Shuichi Ohara, Tomoyuki Koike, Motoyasu Kusano, Yasuyuki ShimoyamaOsamu Kawamura, Yoshio Hoshihara, Kouji Yakabi, Mitsushige Sugimoto, Masafumi Nishino, Makoto Sasaki, Fujiwara Yasuhiro Fujiwara, Kazuhide Higuchi, Ken Haruma, Noriaki Manabe, Kyoichi Adachi, Kenji Furuta, Kazuma Fujimoto

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

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 (PPIs). Method: The subjects comprised 94 patients with NERD (n=71) or mild RE (n=23). Tissue was biopsied from 5cm above the squamo-columnar junction (SCJ), and the degree or presence of nine histopathological markers was assessed. The patients were treated with rabeprazole (RPZ) 10mg once daily for 4 weeks. If complete heartburn relief was not achieved, RPZ was increased to 10mg twice daily for another 2 weeks, and then to 20mg twice daily for another 2 weeks if heartburn remained. Results: Features of esophageal histopathology 5cm 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.

Original languageEnglish
Pages (from-to)479-487
Number of pages9
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume28
Issue number3
DOIs
Publication statusPublished - 2013 Mar

Keywords

  • Dilated intercellular spaces
  • Esophageal histopathology
  • Gastroesophageal reflux disease
  • PGP 9.5
  • Rabeprazole

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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