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Introduction
Reflux esophagitis (RE) is an inflammation of the lower esophagus due to the regurgitation of gastric acid, characterized by a burning pain in the chest (so-called heartburn) and nausea following eating. RE is usually a result of a malfunction of the lower esophageal sphincter (1). In addition, it is associated with an increase in gastric acid secretion and a westernization of lifestyle and diet (i.e. a high-fat diet), as well as a low prevalence of Helicobacter pylori (H. pylori) infection.
H. pylori is generally accepted as the most important type of bacteria in gastrointestinal disease. However, certain studies have suggested that the increased prevalence of RE following H. pylori eradication may be due to the protective role of H. pylori infection in patients with RE (2–4).
In humans, prolonged gastroesophageal reflux, including acidic gastric fluid, leads to esophageal mucosal injury, such as bleeding, erythema, erosions and ulcers (5). Medication used to treat RE include antacids, acid blockers, gastric motility agents and surgery. Acid blockers, which comprise histamine type 2 (H2) antagonists and proton pump inhibitors (PPIs), are the most commonly used treatments for RE. H2 antagonists, such as ranitidine and cimetidine, reduce acid production in the stomach, and PPIs, such as omeprazole and esomeprazole, also arrest the production of stomach acid (6). Usually, PPIs are more effective than H2 antagonists (7,8). However, in spite of the marked therapeutic effect, a number of patients have suffered from incidences of relapse and shown incomplete mucosal healing, continued symptoms and complications (9,10). Even with an adequate administration of H2 antagonists and PPIs, 40–60% of patients have suffered from stricture of the esophagus or cancer, instead of recovering from the RE (8).
Previous studies have revealed a number of serious and unusual side-effects resulting from the long-term use of PPIs, such as hypomagnesemia, bowel symptoms and small intestinal bacterial overgrowths (11,12). As a consequence of this fact, there are, at present, safety concerns regarding the long-term use of PPIs, making it necessary to search for effective and safe alternatives (13). Our previous study was carried out to evaluate the potential therapeutic effect of Curculiginis Rhizoma in RE by the suppression of proinflammatory cytokines (14). The reduction of factors that are associated with inflammation is important in the alleviation...