Li Yu-Wen, Sifrim Daniel, Xie Chenxi, Chen Minhu, Xiao Ying-Lian
Department of Gastroenterology, First affiliated Hospital, Sun Yat-sen University, Guangzhou, GuangDong Province, China.
Wingate Institute of Neurogastroenterology, Queen Mary University of London, London, UK.
J Neurogastroenterol Motil. 2017 Oct 30;23(4):517-525. doi: 10.5056/jnm16178.
BACKGROUND/AIMS: Increased salivary pepsin could indicate an increase in gastro-esophageal reflux, however, previous studies failed to demonstrate a correlation between salivary pepsin concentrations and 24-hour esophageal acid exposure. This study aims to detect the salivary pepsin and to evaluate the relationship between salivary pepsin concentrations and intercellular spaces (IS) in different gastroesophageal reflux disease phenotypes in patients.
A total of 45 patients and 11 healthy volunteers were included in this study. All subjects underwent upper gastrointestinal endoscopy, 24-hour ambulatory multichannel impedance-pH (MII-pH) monitoring, and salivary sampling at 3-time points during the 24-hour MII-pH monitoring. IS were measured by transmission electron microscopy, and salivary pepsin concentrations were determined by enzyme-linked immunosorbent assay.
The IS measurements were greater in the esophagitis (EE), non-erosive reflux disease (NERD), and hypersensitive esophagus (HO) groups than in the functional heartburn (FH) and healthy volunteer groups, and significant differences were indicated. Patients with NERD and HO had higher average pepsin concentrations compared with FH patients. A weak correlation was determined between IS and salivary pepsin among patients with NERD ( = 0.669, = 0.035).
We confirmed the presence of a higher level of salivary pepsin in patients with NERD than in patients with FH. Salivary pepsin concentrations correlated with severity of mucosal integrity impairment in the NERD group. We suggest that in patients with NERD, low levels of salivary pepsin can help identify patients with FH, in addition the higher the pepsin concentration, the more likely the severity of dilated IS.
背景/目的：唾液中胃蛋白酶水平升高可能提示胃食管反流增加，然而，以往研究未能证实唾液胃蛋白酶浓度与24小时食管酸暴露之间存在相关性。本研究旨在检测唾液胃蛋白酶，并评估患者不同胃食管反流病表型中唾液胃蛋白酶浓度与细胞间隙（IS）之间的关系。
本研究共纳入45例患者和11名健康志愿者。所有受试者均接受了上消化道内镜检查、24小时动态多通道阻抗-pH（MII-pH）监测，并在24小时MII-pH监测期间的3个时间点采集唾液样本。通过透射电子显微镜测量IS，采用酶联免疫吸附测定法测定唾液胃蛋白酶浓度。
食管炎（EE）、非糜烂性反流病（NERD）和高敏食管（HO）组的IS测量值高于功能性烧心（FH）组和健康志愿者组，差异有统计学意义。与FH患者相比，NERD和HO患者的平均胃蛋白酶浓度更高。NERD患者中，IS与唾液胃蛋白酶之间存在弱相关性（r = 0.669，P = 0.035）。
我们证实NERD患者唾液胃蛋白酶水平高于FH患者。NERD组唾液胃蛋白酶浓度与黏膜完整性损害的严重程度相关。我们认为，在NERD患者中，低水平的唾液胃蛋白酶有助于识别FH患者，此外，胃蛋白酶浓度越高，IS扩张的可能性越大。
