The prospective study on the effect of ilaprazole in non-erosive reflux disease patients : focused on histologic findings and inflammatory biomarker

Abstract

INTRODUCTION： Patients with non―erosive reflux disease （NERD） are less responsive to proton pump inhibitors （PPIs） than patients with erosive esophagitis． The aim of this study was to objectively evaluate the effect of a new PPI， ilaprazole， on NERD， assessed using symptom scores， histopathologic findings， and inflammatory biomarkers． MATERIALS AND METHODS： This prospective study was performed at a single hospital and 20 patients given a clinical diagnosis of NERD were enrolled． All patients underwent 24―hr combined multichannel intraluminal impedance and pH esophageal monitoring （MII―pH） before treatment． Patients were treated with ilaprazole （20 mg） once daily for 4 weeks． The GerdQ questionnaire， histologic findings （basal cell hyperplasia， papillary elongation， dilated intercellular spaces， intraepithelial eosinophils， and intraepithelial T lymphocytes）， and inflammatory biomarkers （TNF―α， IL―8， IL―1β， TRPV1， and MCP―1） were used for assessment． Biopsies were obtained from 3 cm above the esophagogastric junction （EGJ） before and after treatment． RESULTS： Based on MII―pH results， 8 patients （40%） were classified as having functional heartburn． Of the remaining patients， 2 were classified as having true NERD and 10 as having a hypersensitive esophagus． No differences were observed in baseline characteristics among subgroups before treatment， except infiltration of intraepithelial T lymphocytes． After treatment with ilaprazole， all patients showed a statistically significant improvement in GerdQ score （P〈 0.001）． In the histopathologic findings， all parameters showed a tendency to improve and some parameters, such as basal cell hyperplasia （P ＝ 0.008）， papillary elongation （P ＝ 0.021）， and infiltration of intraepithelial T lymphocytes （P ＝ 0.008）， improved significantly． Among cytokines， expression of TNF―α （P ＝ 0.049), IL―8 （P ＝ 0.046）, TRPV1 （P ＝ 0.045）， and MCP1 （P ＝ 0.042） decreased significantly after treatment with ilaprazole． CONCLUSION： Daily ilaprazole（20 mg）is efficacious in improving symptom scores, several histopathologic findings, and some inflammatory biomarkers in patients with clinical NERD， irrespective of subtype．