Lansoprazole-induced improvement of esophageal submucosal injury

Abstract

The proton pumpvinhibitor, lansoprazole, is reported to have acid secretion inhibiting effect as well as anti-inflammatory effects such as inhibition of cytokine secretion from inflammatory cells. Clinically, excellent efficacy of lansoprazole is reported for not only gastric ulcer but also gastroesophageal reflux disease (GERD). Since GERD is categorized endoscopically into erosive esophagitis and non-erosive reflux disease, it is important to make accurate assessment of any improvement in the inflammatory process when using endoscopic ultrasonography (EUS) capable of visualizing the submucosal structure. We report here our experience in assessing the effect of treatment with lansoprazole on esophageal wall structure using EUS in patients with GERD. At baseline (before treatment), EUS showed abnormalities in the mucosa, submucosa and muscularis propria caused by inflammation, thickening of the entire esophageal wall and changes in the contractile properties of esophageal smooth muscles reflecting the effects of inflammation on the entire wall of the lower esophagus in reflux esophagitis regardless of whether it is erosive or endoscopically-negative. Treatment with lansoprazole resulted in normalization of esophageal wall structure and improvement of motility, suggesting that lansoprazole improves not only mucosal inflammation but also submucosal inflammation in GERD.

Keywords: GERD; endoscopic ultrasonography; esophageal wall structure; lansoprazole.

Fig. 1

Endoscopic ultrasonographic images of the esophageal wall. Comparison of submucosal and muscular layers between normal subjects (A) and patients with reflux esophagitis (B). Note the marked thickening of the submucosal and muscular layers in (B) with changes in echo density. Reprinted with permission [21].

Fig. 2

Analysis of EUS findings after treatment of GERD patients. EUS analysis was performed after 16 weeks of treatment. The stratal structure of the esophageal wall was well maintained in most cases of the lansoprazole-stepped-down group (A, white arrow). While reduction of the esophageal submucosal layer was observed, no change was noted in the mucosal surface in the famotidine stepped-down group (B, white arrow). Reprinted with permission [31].