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- Title
Impaired Mucosal Integrity in Proximal Esophagus Is Involved in Development of Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease.
- Authors
Norita, Kazuaki; Asanuma, Kiyotaka; Koike, Tomoyuki; Okata, Tomoki; Fujiya, Taku; Abe, Yasuaki; Nakagawa, Kenichiro; Hatta, Waku; Uno, Kaname; Nakamura, Tomohiro; Nakaya, Naoki; Asano, Naoki; Imatani, Akira; Shimosegawa, Tooru; Masamune, Atsushi
- Abstract
Background and Objective: Weakly acidic reflux reaching to the proximal esophagus is closely related to the perception of gastroesophageal reflux in patients with nonerosive reflux disease despite treatment with a proton pump inhibitor (PPI). However, little is known about the involvement of the patients' mucosal integrity of the proximal esophagus. Methods: We recruited 15 symptomatic nonerosive gastroesophageal reflux disease (GERD) patients with a positive symptom index despite PPI treatment and 11 healthy asymptomatic volunteers as controls. The biopsy specimens obtained from the proximal and distal esophagus were applied to a mini-Ussing chamber system to measure transepithelial electrical resistance (TEER) against a pH 4 weak acid. The esophageal biopsy samples were subjected to quantitative real-time PCR and immunohistochemical analysis. Results: In the proximal esophagus, the weak acid exposure reduced the TEER in the PPI-refractory patients compared to that in the controls. The frequency of the reflux extending to the proximal esophagus had a significant correlation with the reduction in the proximal esophageal TEER in the patients. The reduced TEER in the proximal esophagus was accompanied by an increase in IL-8 and IL-1β mRNA and a decrease in occludin mRNA levels. The proximal esophageal mucosa in the patients presented infiltration of CD3-positive lymphocytes and an increased expression of solute carrier organic anion transporter family member 2A1 (SLCO2A1), a passage gate of reflux symptom-evoking molecules. Conclusions: The reflux perception is related to an impairment of the proximal esophageal mucosal integrity in patients with nonerosive reflux disease despite PPI.
- Subjects
HEARTBURN; NON-erosive reflux disease; ORGANIC anion transporters; ESOPHAGUS; PROTON pump inhibitors; PROTONS
- Publication
Digestion, 2021, Vol 102, Issue 3, p404
- ISSN
0012-2823
- Publication type
Article
- DOI
10.1159/000508661