Anti-Inflammatory Medications in the Treatment of Gastroesophageal Reflux Disease

10th Japan-Korea Joint Symposium on Helicobacter Infection - Asian Perspective in Helicobacter Research -

Symposium 1. Recent update on the role of inflammation in upper gastrointestianal diseases Anti-inflammatory medications in the treatment of gastroesophageal reflux disease

Su Jin Hong Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea

EDUCATION AND TRAINING 1986∼1992 Bachelor, College of Medicine, Soonchunhyang University 1994∼1996 Master, College of Medicine, Soonchunhyang University 1997∼2000 Ph. Doctor, College of Medicine, Soonchunhyang University

PROFESSIONAL EXPERIENCES 1992∼1993 Internship, Soonchunhyang University Hospital 1993∼1997 Residency, Internal Medicine, Soonchunhyang University Hospital 1997∼2000 Fellowship, Department of Gastroenterology and Hepatology, Soonchunhyang University Hospital 2000∼2002 Instructor of Internal Medicine, Hallym University College of Medicine, Department of Gastroenterology and Hepatology, Kangnam Sacred Heart Hospital 2002∼2007 Assistant professor of Internal Medicine, Soonchunhyang University College of Medicine, Department of Gastroenterology and Hepatology, Soonchunhyang University Bucheon Hospital 2007∼2011 Associate professor of Internal Medicine, Soonchunhyang University College of Medicine, Department of Gastroenterology and Hepatology, Soonchunhyang University Bucheon Hospital 2012∼Present Professor of Internal Medicine, Soonchunhyang University College of Medicine, Department of Gastroenterology and Hepatology, Soonchunhyang University Bucheon Hospital

21 10th Japan-Korea Joint Symposium on Helicobacter Infection - Asian Perspective in Helicobacter Research -

[Abstract]

Introduction

Reflux esophagitis occurs due to gastroesophageal reflux of gastroduodenal contents. These provokes tissue damage or inflammation on the normal mucous membrane of the esophagus and leads to accumulation of various physical, chemical and biological factors (heat, K+, H+, histamine, 5-HT, bradykinin, PGE2 and cytokines) which cause neural sensitization through specific receptors or cellular messengers to show symptoms. To treat reflux esophagitis proton pump inhibitors are widely used as an optimal treatment. In the meantime, nonerosive gastroesohageal reflux disease with a normal mucosa endoscopically as well as reflux esophagitis with an erosive mucosa was reported to be associated with infiltration of inflammatory cells and more expression of IL-8 on the esophageal mucosa.1 Therefore, a medication which can reduce the inflammatory process, is considered to be helpful in improving symptoms of reflux esophagitis. Rebamipide is a drug stimulating the synthesis of prostaglandin and mucous glycoprotein, inhibiting active oxygen, inflammatory cytokine and chemokine and sup- pressing the activity of leukocytes, and it is recognized as a representative defensive medication against inflammatory processes. It was found that rebamipide as an effective ther- apeutic agent for gastritis led to effective symptomatic response and improvement of endoscopic and histologic gastritis in chronic gastritis patients with dyspepsia refractory to proton pump inhibitors.2 Rebamipide alreadyshowed to have effectiveness on reducing the inflammatory cytokine in the animal experiment and esophageal mucosa of patients with reflux esophagitis. In addition, a lot of reflux esophagitis patients had gastritis.3 Therefore, rebamipide is expected to help the alleviation of symptoms in reflux esophagitis patients who even have endoscopic gastritis. A clinical trial was performed to determine the efficacy of combined therapy of esomeprazole and rebamipide easing symptoms compared to monotherapy of esomeprazole in the patients with reflux esophagitis. A total of 243 patients with reflux esophagitis were enrolled in this study. We analyzed the 212 patients’ data amongthe enrolled patients. The characteristics of the patients were not different between the two groups. The changes of symptoms were calculated for four-week administration period in each group. The total symptom scores were significantly decreased after 4 weeks in both groups. Especially, in the patients with high-symptom score, symptom reduction in the combination therapy group was larger than that of monotherapy group during the middle period of the 4 weeks. It suggests that the combination therapy rapidly decrease the symptoms of the patients with severe symptom in the initial treatment period.

22 Su Jin Hong: Anti-inflammatory medications in the treatment of gastroesophageal reflux disease

References

1. Yoshida N, Uchiyama K, Kuroda M, et al. Interleukin-8 expression in the esophageal mucosa of patients with gastroesophageal reflux disease. Scand J Gastroenterol 2004;39:816-822. 2. Chitapanarux T, Praisontarangkul OA, Lertprasertsuke N. An open-labeled study of rebamipide treatment in chronic gastritis patients with dyspeptic symptoms refractory to proton pump inhibitors. Dig Dis Sci 2008;53:2896-2903. 3. Peura DA, Haber MM, Hunt B, Atkinson S. Helicobacter pylori-negative gastritis in erosive esophagitis, nonerosive reflux disease or functional dyspepsia patients. J Clin Gastroenterol 2010;44:180-185.