الفهرس 
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Abstract
Gastroesophageal reflux disease (GERD) is a condition that develops by reflux of the stomach contents into the esophagus, and causes troublesome symptoms, such as heartburn and regurgitation.
Refractory GERD is generally defined as the persistence of typical symptoms that don’t respond to stable, twice-daily proton pump inhibitors (PPI) dosing during at least 8-12 weeks of treatment.
Studies have shown an increase in proinflammatory TH1 cytokines in reflux esophagitis compared to Barrett’s oesophagitis, whereas TH2 cytokines are predominant in Barrett’s oesophagitis. There is increase in IL-4 in Barrett’s oesophagitis, in another study the level of IL-4 was significantly higher in patients with Barrett’s esophagus than in ulcerative, erosive esophagitis, NERD patients and healthy volunteers.
The aim of this study is to evaluate the serum level of IL4 in patients with GERD and patients with refractory GERD.
This current case control study was conducted on 50 patients from gastrointestinal endoscopy units in the following hospitals, Ain Shams University Hospital, Kafr El Sheikh Cardiac and Liver Center, Kafr El Sheikh General Hospital.
The study included two groups of patients, Group-1 including 25 patients with GERD symptoms who didn’t receive treatment or who received treatment for less than 8 weeks with improvement of symptoms and Group-2 including 25 Patients with refractory GERD and who received PPIs for more than 8 weeks without improvement of symptoms.
All patients were subjected to history taking, clinical examination, upper gastrointestinal endoscopy with biopsy from lower end of esophagus, laboratory investigations as (CBC, PT, PTT, INR, AST, ALT, Total bilirubin, Direct bilirubin, Indirect bilirubin, Creat, Urea, Na, K) and serum IL4 level by ELISA.
In the current study, there is no statistically significant difference between the two groups as regard sex and age.
According to endoscopic and microscopic examination there is statistically significant difference between the two groups. In the group of GERD there is reflux oesophagitis in all cases and in the group of refractory GERD there is reflux oesophagitis in 72% of cases and Barrett’s oesophagitis in 28 % of cases of refractory GERD and 14 % from all cases participating in the study.
Pathological features that we found in patients with GERD were moderate reflux oesophagitis (52%) more than mild reflux oesophagitis (40%) more than severe reflux oesophagitis (8%), while in patients with refractory GERD there were severe reflux oesophagitis (56%) more than Barrett’s esophagitis (28%) more than moderate reflux oesophagitis (16%).
Relation between Pathology and Endoscopy was reported in the two groups of patients, in the group of GERD relation between pathology and all endoscopic finding was not statistically significant except with lower end oesophageal ulcers that were found in the cases with severe reflux oesophagitis only. It was statistically high significant.
In the group of refractory GERD the pathology reported that 28% of patients have Barrett’s oesophagitis and the other 72% have reflux esophagitis (moderate 16%, and severe 56%). Relation between pathology and endoscopy was statistically high significant as regard reflux oesophagitis and Barrett’s oesophagitis.
Relation between Interleukin-4, age and other laboratory investigations in the group of GERD and the group of refractory GERD revealed non statistically significance.
Comparison between the two groups, the group of GERD and the group of refractory GERD as regard IL4 level revealed that there is statistically significant difference between the two groups as regard serum IL4 level, as serum IL4 level was elevated in the group of refractory GERD more than the group of GERD.
Relation between serum IL4 and pathological findings in each group included in the study revealed statistically significant difference, in the group of GERD IL4 was elevated in the cases of severe reflux oesophagitis more than moderate reflux oesophagitis more than mild reflux oesophagitis, there is statistically significant difference. While in patients with refractory GERD IL4 was elevated in the cases of Barrett’s oesophagitis more than the cases of reflux oesophagitis, there is statistically high significant difference.
Comparison between the two groups as regard comorbidity and routine laboratory investigations revealed non statistically significant difference.
Finally, there is acceptable discriminative and predictive ability of Interleukin-4 between GERD and refractory GERD groups as indicated by the area under the ROC curve (Receiver operator characteristic curve) that was 0.6. Interleukin-4 had sensitivity 56% and specificity 76% at cut off rate of >58.25 to discriminate between GERD and Refractory GERD