Acid Reflux, Esophageal Damage, and the Immune Response
Acid reflux disease (GERD) is now the most common upper gastrointestinal disease in Western countries, and its prevalence is on the rise. Most people with this condition are treated with acid reducers or PPI medications. However, for up to 40 percent of patients, these medications don’t provide adequate control of their disease.
Accurately understanding how acid reflux disease damages the esophagus is key in developing better treatments for the future.
How we used to think acid reflux damaged the esophagus
Current guidelines are based on the idea that damage from acid reflux disease (and concurrent issues with the esophagus) occurs when acidic stomach contents splash backward, out into the esophagus. The acid, which isn’t supposed to be there, causes damage or irritation to the esophagus. Treatments are focused on reducing the acid in a patient’s stomach to give the esophagus time to heal. In some instances, additional steps, such as surgery, are needed to prevent the stomach contents from splashing back.
What the latest research says
A study published in May 2016 in theJournal of the American Medical Association found a new mechanism of esophageal damage. Twelve patients at the VA North Texas Health Care System's Dallas VA Medical Center who had esophagitis caused by acid reflux were studied. After completing successful treatment with PPI medications -- resulting in healing of the esophagus -- the patients stopped the medication. Knowing that the reflux esophagitis was likely to reoccur, the researchers kept a close eye on the changes within each patient’s esophagus. This was done through pH and impedance monitoring and esophagoscopy (with biopsy).
In 11 of the 12 patients, the damage to the esophagus did reoccur but the early damage was not associated with a chemical-type burn as previously thought. What researchers found instead was stomach acid didn’t directly cause the damage, but stimulated the esophagus to make small proteins called cytokines. Cytokines then set up the processes of esophageal inflammation and injury.
What does this mean for treating acid reflux?
For now, the treatment of acid reflux disease will still focus on reducing the acid. However, future studies will likely delve into more novel treatments that focus on the immune response associated with the esophageal damage. This may provide hope for the thousands of patients who are not finding adequate relief from current medications.
Jennifer has a bachelor's degree in dietetics as well as graduate work in public health and nutrition. She has worked with families dealing with digestive disease, asthma and food allergies for the past 12 years. Jennifer also serves the Board of Directors for Pediatric Adolescent Gastroesophageal Reflux Association (PAGER).