Ocular Surface Disease may be manifestation of GERD

A new study published in Cornea suggests that there was an increase in prevalence of ocular discomfort in patients with GERD/LPR. Further the observations of vasoactive intestinal peptide (VIP) and neuropeptide Y transcripts demonstrate the potential neurogenic nature of the inflammatory state.

Common gastrointestinal illnesses with extraesophageal symptoms (EGERD) include gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR). GERD/LPR and eye pain have been linked in studies. Antonio Di Zazzo and colleagues undertook this study to assess the incidence of ocular involvement among individuals with GERD/LPR, characterize clinical and biomolecular signs, and suggest a therapeutic plan for this unique EGERD.

This masked randomized controlled research included 53 LPR patients and 25 healthy controls. With a 1-month follow-up, fifteen naïve individuals with LPR were treated with magnesium alginate eye drops and oral treatment (magnesium alginate and simethicone tablets). A clinical eye surface examination, the eye Surface Disease Index questionnaire, tear sample, and conjunctival imprinting were all conducted. ELISA was used to measure tear pepsin levels. Imprints were subjected to immunodetection for human leukocyte antigen-DR isotype (HLA-DR) and transcript expression (PCR) for HLA-DR, mucin 5AC (MUC5AC), IL8, nicotine adenine dinucleotide phosphate (NADPH), vasoactive intestinal peptide, and neuropeptide Y.

The key findings of this study were:

When compared to controls, patients with LPR showed substantially greater Ocular Surface Disease Index (P 0.05), lower T-BUT (P 0.05), and higher meibomian gland dysfunction (P 0.001).

Tear break-up time (T-BUT) and meibomian gland dysfunction scores returned to normal following therapy.

Pepsin levels rose considerably in EGERD patients (P = 0.01) and dropped significantly after topical therapy (P = 0.0025).

HLA-DR, IL8, and NADPH transcripts were considerably higher in the untreated group compared to the controls, and similar significant values were found following therapy (P 0.05).

MUC5AC expression increased considerably with treatment (P = 0.005).

VIP transcripts were greater in EGERD than in controls and reduced after topical therapy (P 0.05). In NPY, no significant alterations were detected.

Reference:

Di Zazzo, A., Micera, A., Surico, P. L., Balzamino, B. O., Luccarelli, V., Antonini, M., Coassin, M., & Bonini, S. (2023). Ocular Surface Disease as Extraesophageal Gastroesophageal Reflux Disease Manifestation: A Specific Therapeutic Strategy. In Cornea. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/ico.0000000000003329