Advances in Understanding Inflammation in Esophageal Disease

Gastroesophageal reflux disease (GERD) is a common chronic disorder that causes reflux symptoms and/or muscosal damage, associated with Barrett’s esophagus and esophageal adenocarcinoma, and greatly impacts on the quality of life. Gastric acid plays a critical role in the pathogenesis especially in regard to inflammation of the esophageal mucosa and initiating symptoms; the more the acid reflux, the more severe the disease. It is known that many inflammatory mediators such as cytokines are involved in the control of acid secretion but they are also involved in the inflammatory response to the injurious acidic refluxate which results in mucosal lesions. Current research suggests that the microbiota of the esophagus is changed in across the spectrum of reflux disease. Proton pump inhibitors are still the mainstay of medical treatment for GERD and may have additional anti-inflammatory effects which also contribute to a chemical prevention effect in Barrett’s esophagus.