Song In Ji, Kim Hyun Ki, Lee Na Keum, Lee Sang Kil
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2018 Oct;59(8):951-959. doi: 10.3349/ymj.2018.59.8.951.
Patients with gastroesophageal reflux disease without esophagitis show varying responses to proton pump inhibitors (PPIs). The aim of this study was to objectively evaluate the effect of a new PPI, ilaprazole, on patients with heartburn but without reflux esophagitis.
This prospective study was performed on 20 patients with heartburn but without reflux esophagitis. All patients underwent upper endoscopy and 24-hr combined multichannel intraluminal impedance and pH esophageal monitoring (MII-pH). They were then treated with ilaprazole (20 mg) once daily for 4 weeks. The GerdQ questionnaire, histologic findings, and inflammatory biomarkers were used for assessment before and after ilaprazole.
Among the 20 patients, 13 (65%) showed GerdQ score ≥8. Based on MII-pH results, patients were classified as true nonerosive reflux disease (n=2), hypersensitive esophagus (n=10), and functional heartburn (n=8). After treatment, patients showed a statistically significant improvement in GerdQ score (<0.001). Among histopathologic findings, basal cell hyperplasia, papillary elongation, and infiltration of intraepithelial T lymphocytes improved significantly (=0.008, =0.021, and =0.008; respectively). Expression of TNF-α, IL-8, TRPV1, and MCP-1 decreased marginally after treatment (=0.049, =0.046, =0.045, and =0.042; respectively).
Daily ilaprazole (20 mg) is efficacious in improving symptom scores, histopathologic findings, and inflammatory biomarkers in patients with heartburn but no reflux esophagitis.
无食管炎的胃食管反流病患者对质子泵抑制剂（PPI）的反应各不相同。本研究的目的是客观评估新型PPI艾普拉唑对烧心但无反流性食管炎患者的疗效。
本前瞻性研究对20例烧心但无反流性食管炎的患者进行。所有患者均接受了上消化道内镜检查以及24小时食管腔内多通道阻抗与pH联合监测（MII-pH）。然后他们接受艾普拉唑（20毫克）每日一次，共4周的治疗。在使用艾普拉唑前后，使用GerdQ问卷、组织学检查结果和炎症生物标志物进行评估。
20例患者中，13例（65%）的GerdQ评分≥8。根据MII-pH结果，患者被分为真性非糜烂性反流病（n = 2）、高敏食管（n = 10）和功能性烧心（n = 8）。治疗后，患者的GerdQ评分有统计学意义的改善（<0.001）。在组织病理学检查结果中，基底细胞增生、乳头延长和上皮内T淋巴细胞浸润均有显著改善（分别为=0.008、=0.021和=0.008）。治疗后肿瘤坏死因子-α、白细胞介素-8、瞬时受体电位香草酸亚型1和单核细胞趋化蛋白-1的表达略有下降（分别为=0.049、=0.046、=0.045和=0.042）。
每日服用艾普拉唑（20毫克）对改善烧心但无反流性食管炎患者的症状评分、组织病理学检查结果和炎症生物标志物有效。
