Histological effects of esomeprazole therapy on the squamous epithelium of the distal oesophagus

Abstract

Background Proton pump inhibitor therapy has been reported to reduce proliferative changes of the oesophagus significantly in gastro‐oesophageal reflux disease (GERD). Aim To assess the histological effects of esomeprazole treatment on the oesophagus. Methods Data were derived from a subgroup of patients participating in the proGERD study, who had either erosive reflux disease (n = 720) or non‐erosive reflux disease (n = 35) and who had biopsy data from two sites [(i) 2 cm above the z‐line and (ii) at the z‐line], obtained at baseline and following treatment with esomeprazole. Proliferative changes of the squamous epithelium were assessed histologically by measuring thickness of the basal cell layer and elongation of the papillae as a percentage of the whole epithelial thickness. Results In erosive reflux disease patients, the thickness of the basal cell layer and length of the papillae pretreatment were associated with the severity of oesophagitis (P < 0.05), at both biopsy sites. After esomeprazole treatment, baseline thickness and length of papillae were significantly reduced (P < 0.05) at both biopsy sites in non‐erosive reflux disease and erosive reflux disease patients (particularly those with Los Angeles grades C and D). Conclusion This demonstrates a strong correlation between severity of GERD and histological parameters. Esomeprazole therapy resulted in clear reversal of proliferative changes observed prior to treatment in the squamous epithelium at both biopsy locations.