Systemic Inflammatory Response in Patients with Gastroesophageal Reflux Disease

Vladimir Ivashkin¹, Yulia Evsyutina^1, , Alexander Trukhmanov¹, Svetlana Lyamina² and Igor Malyshev²

¹Department of Internal Disease Propaedeutics, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University, Moscow, Russian Federation

²Department of Pathophysiology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation

Cite this paper

Vladimir Ivashkin, Yulia Evsyutina, Alexander Trukhmanov, Svetlana Lyamina and Igor Malyshev. Systemic Inflammatory Response in Patients with Gastroesophageal Reflux Disease. American Journal of Clinical Medicine Research. 2015; 3(4):64-69. doi: 10.12691/AJCMR-3-4-2

Abstract

Aim. To characterize the systemic inflammatory response in patients with various forms of GERD. Materials and methods. The prospective clinical study included 45 patients with GERD and 10 healthy volunteers. An analytic survey of all participants was carried out which included, the collection of complaints and anamnesis, the identification of risk factors for GERD; esophagogastroduodenoscopy and a 24-hour esophageal pH-impedance monitoring. Using the method of flow cytometry, the levels of 7 cytokines were determined: two anti-inflammatory - IL-4 and IL-10, three pro-inflammatory - IL-8, IFN-γ and TNF-α, and two cytokines which may manifest as anti-inflammatory as well as pro-inflammatory activity depending on the circumstances (bivalent) - IL-2 and IL-6. Results. In patients with erosive and ulcerative esophagitis when compared to patients with NERD, Barrett's esophagus and healthy individuals, there was an increased expression of pro-inflammatory cytokines. Whereas in patients with Barrett's esophagus, when compared to other patients and healthy individuals, there was a resultant overexpression of anti-inflammatory cytokines. The levels of TNF-α and IL-8 correlates with the total number of acid reflux and acid bolus exposure, whereas the levels of IL-4 and IL-10 correlate with the total number of weakly alkaline reflux and weakly alkaline bolus exposure. The high level of IL-8 was associated with an increased incidence of recurrence of erosive esophagitis, despite the ongoing therapy for 2 years. Conclusions. In patients with erosive and ulcerative esophagitis in comparison with patients with NERD and Barrett's esophagus, there is a predomination in the production of pro-inflammatory cytokines such as IL-8, IFN-γ and TNF-α, indicating the development of Th1 immune response. In patients with Barrett's esophagus, there was an increased expression of anti-inflammatory cytokines such as IL-4 and IL-10, indicating the formation of the Th2 immune response.

Keywords

gastroesophageal reflux disease, systemic inflammatory response, cytokines

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	El-Serag H.B., Ergun G.A., Pandolfino J., Fitzgerald S., Tran T., Kramer J.R. Obesity increases oesophageal acid exposure // Gut. - 2007. Vol.56. p. 749-755.
[2]	Ivashkin V.Т., Trukhmanov A.S. Diagnosis and treatment of gastroesophageal reflux disease. Manual for physicians. 2010.
[3]	Lazebnik L.B., Bordin D. S., Masharova А.А., et al. «Restoring the quality of life and preventing heartburn elimination alginate»: results of a multicenter study VIA APIA // Experimental and Clinical Gastroenterology. 2010. №6. p. 70-76.
[4]	Maev I.V., Vyuchkova E. S., Chekina M.I. Gastroesophageal reflux disease - a disease of the XXI century // The Physician. 2004. №4. – p. 10-14.
[5]	Trukhmanov A.S. Gastroesophageal reflux disease: clinical options, prognosis, treatment: the thesis on scientific degree of Doctor of Medical Sciences.- 2008.
[6]	Evsyutina Yu.V., Trukhmanov A.S. Lack of response to therapy with proton pump inhibitors: the causes and tactics of patients // Ther archive 2015. 2. p. 85-89.
[7]	Bytzer P., van Zanten S.V., Mattsson H., Wernersson B. Partial symptomresponse to proton pump inhibitors in patients with nonerosive reflux disease or reflux oesophagitis – a post hoc analysis of 5796 patients // Aliment Pharmacol Ther. 2012. Vol.36. p. 635-643.
[8]	Cicala M., Emerenziani S., Guarino M.P., Ribolsi M. Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease // World J Gastroenterol. 2013. Vol.19. № 39. – p. 6529-6535.
[9]	Bulgakov S.A. The phenomenon of nocturnal acid breakthrough during treatment with proton pump inhibitors and therapeutic correction // Pharmateka. 2012. № 13. p. 62-66.
[10]	Isomoto H., Inoue K., Kohno S. Interleukin-8 levels in esophageal mucosa and long-term clinical outcome of patients with reflux esophagitis // Scand J Gastroenterol. 2007. Vol.42. p. 410-411.
[11]	Kohata Y., Fujiwara Y., Machida H., Okazaki H., Yamagami H., Tanigawa T, Watanabe K., Watanabe T., Tominaga K., Wei M., Wanibuchi H., Arakawa T. Role of Th-2 cytokines in the development of Barrett's esophagus in rats // J Gastroenterol. 2011. Vol.46. №7. p. 883-893.
[12]	Zhong Y.Q., Lin Y., Xu Z. Expression of IFN-γ and IL-4 in the esophageal mucosa of patients with reflux esophagitis and Barrett's esophagus and their relationship with endoscopic and histologic grading // Dig Dis Sci. 2011.Vol.56. №10. p. 2865-2870.