Cezary Poplawski

The potential role of the esophageal pre-epithelial barrier components in the maintenance of integrity of the esophageal mucosa in patients with endoscopically negative gastroesophageal reflux disease

OBJECTIVE:Patients with gastroesophageal reflux disease (GERD) accompanied by erosive reflux esophagitis (RE) exhibit an impairment within the esophageal pre-epithelial barrier protective components that may facilitate the development and/or progression of the mucosal injury. Little is known, however, whether such impairment is a general phenomenon affecting all patients with GERD or whether this is a characteristic feature only of patients with erosive RE. We therefore studied the rate of secretion of esophageal inorganic and organic protective factors in patients with endoscopically negative [E (−)] GERD and compared these results with the corresponding values in asymptomatic volunteers (CTRL).METHODS:The study was conducted on 33 white asymptomatic volunteers and 10 white patients with a long history of GERD confirmed by 24-h pH monitoring and a grossly negative upper endoscopy. Esophageal secretion was collected during mucosal exposure to NaCl, HCl, HC/pepsin and NaCl using the esophageal perfusion catheter. In collected samples all investigated parameters were measured.RESULTS:The pH of esophageal secretion and its content of bicarbonate, EGF, and PGE2 in patients with E (−) GERD and asymptomatic volunteers were similar. Unexpectedly, the rate of esophageal glycoconjugate (predominantly mucin) secretion was significantly higher in patients with E (−) GERD than in controls during perfusion with HCl (p < 0.05). Furthermore, secretion of protein in patients with E (−) GERD was significantly higher than in the control group during the mucosal exposure to HCl/Pepsin (p < 0.05). The nonbicarbonate buffer secretion during perfusion with HCl and HCl/Pepsin as well as the rate of esophageal TGFα output during infusion of final saline in patients with E (−) GERD were significantly lower than in CTRL group (p < 0.05).CONCLUSIONS:Our data indicate that patients with E (−) GERD have an esophageal secretory potential, in terms of glycoconjugate and protein, higher than that in asymptomatic controls. This phenomenon in patients with E (−) GERD may, by enhancing the quantity of the esophageal pre-epithelial barrier, help to prevent the development of erosive esophagitis. A significantly lower esophageal secretory response in patients with E (−) GERD in terms of nonbicarbonate buffers and TGFα may facilitate the development of GERD symptoms and histological changes of GERD, respectively.

Salivary protective potential is significantly enhanced by stimulation induced both by mastication and esophago-salivary reflex: its clinical significance

Purpose: An increase in the rate of salivary secretion during heartburn symptoms in patients with GERD is a well established phenomenon. Salivary secretion stimulated by mastication exhibits a significantly enhanced protective potential (Gastroenterology, 110:675–81, 1996). Little is known, however, regarding the interrelationship between the rate of secretion of each individual protective factor in basal conditions and during stimulation. Therefore, the aim of the study was to explore the correlation between the rate of secretion of salivary bicarbonate (BIC), non-bicarbonate (NBIC), protein, glycoconjugate, epidermal growth factor (EGF), transforming growth factor a (TGF ) and prostaglandin E2 (PGE 2) in basal and stimulated (by mastication or esophago-salivary reflex) conditions.

An impairment in esophageal glycoconjugate secretion in patients with reflux esophagitis represents a generalized phenomenon potentially predisposing to the development of mucosal injury

An impairment in esophageal glycoconjugate secretion in patients with reflux esophagitis represents a generalized phenomenon potentially predisposing to the development of mucosal injury

A strong salivary secretory response, in terms of prostaglandin E2, during the upper esophageal mucosal exposure to acid and pepsin could be a factor in prevention of the upper esophageal mucosal injury during gastroesophageal reflux

A strong salivary secretory response, in terms of prostaglandin E2, during the upper esophageal mucosal exposure to acid and pepsin could be a factor in prevention of the upper esophageal mucosal injury during gastroesophageal reflux