Amy Tyberg, MD: GERD as an Inflammatory Disease

Recent clinical assessment of gastroesophageal reflux disease (GERD) has linked it to an inflammatory response triggered by cytokines. The discovery has evidenced the association between the gastroenterological disease and esophagitis—and eventual advances of disease from there—and given clinicians just another comorbidity to keep an eye out for.

In an interview with MD Magazine®, Amy Tyberg, MD, assistant professor, associate director of Endoscopy, and director of Therapeutic EUS at the Rutgers Robert Wood Johnson Medical School, discussed the inflammatory aspect of GERD, and what risks are at hand for untreated patients.

MD Mag: How has clinical care changed with the discovery that GERD is an inflammatory response triggered by cytokines?

Tyberg: I mean, the fact that GERD is an inflammatory component is really important, because it makes it not just about controlling patient symptoms, but it's also a safety issue. We know that GERD now is a precursor for esophagitis, which is an inflammation of the bottom part of the esophagus which can lead to precancerous conditions like Barrett's esophagus, where the mucosa actually changes into other types of cells, and even esophageal cancer.

So, it becomes not just about improving quality of life and making patients feel better, but preventing the development of these other conditions. It's really important that we stay on top of these patients.

MD Mag: Can you describe the role of inflammation in GERD?

Tyberg: I think we definitely need to be more aggressive in terms of keeping an eye on these patients, making sure not just that their symptoms are better, but if they do start to show these signs of esophagitis or Barrett's esophagus that we keep a close eye on them, we surveil them, we make sure that the therapies we’re doing are working, so that they're not progressing and becoming closer to getting things like esophageal cancer.

MD Mag: What makes GERD more difficult to diagnose in children?

Tyberg: I think we know that the acid that refluxes up from the esophagus causes the inflammation that we see leading to esophagitis, and this induces changes that can cause things like Barrett's esophagus , and that it can progress in a small number of patients to esophageal cancer. So it's really a transition that generally happens slowly and one that we can see and hopefully halt the progression by offering these types of treatment.