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A challenge to our view of reflux oesophagitis pathogenesis

Since the recognition of reflux oesophagitis as a disease entity, scientists and clinicians have commonly assumed that the first step in its pathogenesis was a loss of superficial epithelial cells, brought about by caustic acid injury. However, new data suggests that it is time to reconsider this concept.

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Figure 1: Macroscopic and microscopic changes during gastroesophageal reflux.

References

  1. Dunbar, K. B. et al. Association of acute gastroesophageal reflux disease with esophageal histologic changes. JAMA 315, 2104–2112 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Winkelstein, A. Peptic esophagitis: a new clinical entity. JAMA 104, 906–909 (1935).

    Article  Google Scholar 

  3. Ismail-Beigi, F., Horton, P. F. & Pope, C. E. 2nd Histological consequences of gastroesophageal reflux in man. Gastroenterology 58, 163–174 (1970).

    Article  CAS  PubMed  Google Scholar 

  4. Tobey, N. A., Carson, J. L., Alkiek, R. A. & Orlando, R. C. Dilated intercellular spaces: a morphological feature of acid reflux-damaged human esophageal epithelium. Gastroenterology 99, 13–22 (1996).

    Google Scholar 

  5. Souza, R. F. et al. Gastroesophageal reflux might cause esophagitis through a cytokine-mediated mechanism rather than caustic acid injury. Gastroenterology 137, 1776–1784 (2009).

    Article  CAS  PubMed  Google Scholar 

  6. Modlin, I. M. et al. Diagnosis and management of non-erosive reflux disease — the Vevey NERD Consensus Group. Digestion 80, 74–88 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Krugmann, J., Neumann, H., Vieth, M. & Armstrong, D. What is the role of endoscopy and oesophageal biopsies in the management of GERD? Best Pract. Clin. Gastroenterol. 27, 373–385 (2013).

    Article  Google Scholar 

  8. Weijenborg, P. W., Cremonini, F., Smout, A. J. & Bredenoord, A. J. PPI therapy is equally effective in well-defined non-erosive reflux disease and in reflux esophagitis: a meta-analysis. Neurogastroenterol. Motil. 24, 747–757 (2012).

    Article  CAS  PubMed  Google Scholar 

  9. Bruley des Varannes, S., Coron, E. & Galmiche, J. P. Short and long-term PPI treatment for GERD. Do we need more-potent anti-secretory drugs? Best Pract. Res. Clin. Gastroenterol. 24, 905–921 (2010).

    Article  PubMed  Google Scholar 

  10. Sharma, P. et al. Clinical trials: healing of erosive oesophagitis with dexlansoprazole MR, a proton pump inhibitor with a novel dual delayed-release formulation — results from two randomized controlled studies. Aliment. Pharmacol. Ther. 29, 731–741 (2009).

    Article  CAS  PubMed  Google Scholar 

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Correspondence to André J. P. M. Smout.

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Smout, A., Bredenoord, A. A challenge to our view of reflux oesophagitis pathogenesis. Nat Rev Gastroenterol Hepatol 13, 504–505 (2016). https://doi.org/10.1038/nrgastro.2016.106

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