Marcinkiewicz M, Han K, Zbroch T, Poplawski C, Gramley W, Goldin G, Sarosiek J
University of Kansas Medical Center, Gastroenterology Research Laboratory, Kansas City 66160-7350, USA.
Am J Gastroenterol. 2000 Jul;95(7):1652-60. doi: 10.1111/j.1572-0241.2000.02198.x.
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).
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.
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 TGFalpha output during infusion of final saline in patients with E (-) GERD were significantly lower than in CTRL group (p < 0.05).
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 TGFalpha may facilitate the development of GERD symptoms and histological changes of GERD, respectively.
伴有糜烂性反流性食管炎（RE）的胃食管反流病（GERD）患者，其食管上皮前屏障保护成分存在损伤，这可能会促进黏膜损伤的发生和/或进展。然而，尚不清楚这种损伤是影响所有GERD患者的普遍现象，还是仅为糜烂性RE患者的特征性表现。因此，我们研究了内镜检查阴性[E（-）]的GERD患者食管无机和有机保护因子的分泌速率，并将这些结果与无症状志愿者（对照组）的相应值进行比较。
该研究纳入了33名白人无症状志愿者和10名有长期GERD病史的白人患者，这些患者经24小时pH监测确诊且上消化道内镜检查大致正常。使用食管灌注导管在黏膜暴露于氯化钠、盐酸、盐酸/胃蛋白酶和氯化钠的过程中收集食管分泌物。对收集的样本测量所有研究参数。
E（-）GERD患者和无症状志愿者的食管分泌物pH值及其碳酸氢盐、表皮生长因子（EGF）和前列腺素E2（PGE2）含量相似。出乎意料的是，在灌注盐酸期间，E（-）GERD患者的食管糖缀合物（主要是粘蛋白）分泌速率显著高于对照组（p<0.05）。此外，在黏膜暴露于盐酸/胃蛋白酶期间，E（-）GERD患者的蛋白质分泌显著高于对照组（p<0.05）。在灌注盐酸和盐酸/胃蛋白酶期间，E（-）GERD患者的非碳酸氢盐缓冲液分泌以及在灌注最终生理盐水期间食管转化生长因子α（TGFα）输出速率均显著低于对照组（p<0.05）。
我们的数据表明，E（-）GERD患者在糖缀合物和蛋白质方面的食管分泌潜能高于无症状对照组。E（-）GERD患者的这种现象可能通过增加食管上皮前屏障的量来帮助预防糜烂性食管炎的发生。E（-）GERD患者在非碳酸氢盐缓冲液和TGFα方面食管分泌反应显著降低，可能分别促进GERD症状的出现和GERD的组织学改变。
