Evaluation of serum levels of Interleukin-4 in Egyptian patients with refractory gastroesophageal reflux disease

Abstract

Introduction: Gastroesophageal reflux disease is defined as bothersome symptoms and/or complications caused by the reflux of stomach contents. About 40–50% of patients develop refractory gastroesophageal reflux disease (R-GERD), with poor improvement of symptoms with treatment. Many pathogenic mechanisms share in development of R-GERD, among which is the important role of T-helper 1 and T-helper 2 response mediated by cytokines. The interleukin-4 is a cytokine known of its anti-inflammatory effect. In this study, we aimed to evaluate the level of interleukin-4 in Egyptian patients with R-GERD versus those with GERD.

PATIENTS AND Methods: Our study included 25 patients with reflux symptoms who received PPIs for less than 8 weeks with improvement of symptoms, versus 25 patients with refractory reflux symptoms who received PPIs for more than 8 weeks without improvement of symptoms. Interleukin-4 levels were assessed in both groups by ELISA.

Results: There was a statistically significant difference between the two groups as regard interleukin-4 levels (p < 0.012) which was higher in the patients with (R-GERD), the mean level of IL-4 was 37.31 ± 56.07 in GERD group while in R-GERD group, it was 102.78 ± 112.29. The diagnostic accuracy of interleukin-4 revealed a sensitivity of 56% and specificity of 76% at cutoff value >58.25 pg/ml, with an acceptable accuracy of 0.6.

Conclusions: The present study concluded that IL-4 is significantly higher in patients with R GERD with cut off value > 58.25 pg/ml. Therapeutic strategies that modulate the production of IL-4 may provide a good solution for treatment of R GERD.