Association of Acute Gastroesophageal Reflux Disease With Esophageal Histologic Changes
Abstract
Importance The histologic changes associated with acute gastroesophageal reflux disease (GERD) have not been studied prospectively in humans. Recent studies in animals have challenged the traditional notion that reflux esophagitis develops when esophageal surface epithelial cells are exposed to lethal chemical injury from refluxed acid. Objective To evaluate histologic features of esophageal inflammation in acute GERD to study its pathogenesis. Design Patients with reflux esophagitis healed by proton pump inhibitors (PPIs) had 24-hour esophageal pH/impedance monitoring and esophagoscopy [including confocal laser endomicroscopy (CLE)] with biopsies from non-eroded areas of distal esophagus at baseline (on PPIs), 1 and 2 weeks after stopping PPIs. Enrollment began May 2013, follow-up ended July 2015. Setting Single-site, VA hospital. Participants Patients with prior reflux esophagitis and esophageal healing documented at baseline esophagoscopy. Intervention PPIs stopped for 2 weeks. Main Outcome and Measures Twelve patients (11 men, mean age 57.6±13.1 years) completed the study. Primary outcome was change in esophageal inflammation 2 weeks after stopping the PPI, determined by comparing lymphocyte, eosinophil, and neutrophil infiltrates (each scored on a 0–3 scale) in esophageal biopsies. Also evaluated were changes in epithelial basal cell and papillary hyperplasia, surface erosions, intercellular space width, endoscopic grade of esophagitis, esophageal acid exposure and…
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