Department of Microbiology, Pathology and Forensic medicine, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan.
Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, 13133, Jordan.
BMC Pulm Med. 2023 Sep 12;23(1):341. doi: 10.1186/s12890-023-02638-7.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lung infection has represented a global challenge. Intriguingly, it has been shown that the alveolar lung epithelium expresses little Angiotensin Converting Enzyme receptor protein (ACE2), the entry receptor for SARS-CoV-2. Upper airway establishment of infection and translocation to the lung is well documented but other anatomical niches may be relevant to potentially serious lung infection. ACE2 is heavily expressed in the gastrointestinal tract and gastrointestinal symptoms support a clinical diagnosis of Coronavirus disease 2019 (COVID-19). This suggests a research question and the need to gather patient data exploring potential aerodigestive links in SARS-CoV-2 tranlocation and infection which may be relevant in the peripheral lung. This recognizes anatomical proximity and concepts of bi-directional movement between the Gastrointestinal and lung systems in normal physiology and disease. We have therefore explored the potential for gastro oesophageal reflux disease (GORD) micro aspiration and aeorodigestive pathophysiology in a novel prospective investigation of patients hospitalized with COVID-19.
This is a prospective descriptive cohort study of 210 patients who were hospitalized with a confirmed diagnosis of COVID-19. The cohort was divided into three groups of patients based on symptom severity and radiological results. The Reflux Symptom Index (RSI) was used to evaluate the presence and severity of GOR. An RSI greater than 13 is considered to be abnormal. Patients' saliva samples were tested using enzyme-linked immunosorbent assay (ELISA) to determine the level of salivary pepsin among the cohort of patients.
A total of 210 patients with COVID-19 were enrolled in the study with 55.2% (116/210) classified as mildly ill, 31.9% (67/210) moderately ill and 12.9% (27/210) as severely ill. 34% (72/210) of the patients had an RSI score of over 13 and a median salivary pepsin value of 54 ± 29 ng/ml which suggested an incidence of extraesophageal reflux (EOR) in around a third of patients. The presence of respiratory comorbid conditions, an RSI score of over 13 and a salivary pepsin level of > 76ng/ml increased the risk of developing a more severe COVID-19 infection.
The study showed a high prevalence of EOR among the study cohort and provide the first prospective evidence suggesting the potential for aerodigestive pathophysiology including microaspiration in COVID-19 disease. We believe that the results of our study support the need for more extensive research.
严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 肺部感染是全球性的挑战。有趣的是，已经表明肺泡肺上皮细胞表达很少的血管紧张素转换酶受体蛋白 (ACE2)，SARS-CoV-2 的进入受体。上呼吸道感染的建立和转移到肺部已有充分的记录，但其他解剖学龛位可能与潜在的严重肺部感染有关。ACE2 在胃肠道中大量表达，胃肠道症状支持对 2019 年冠状病毒病 (COVID-19) 的临床诊断。这提出了一个研究问题，并需要收集探索 SARS-CoV-2 易位和感染中潜在的气液消化联系的患者数据，这可能与外周肺有关。这认识到解剖学上的接近性以及在正常生理学和疾病中胃肠道和肺部系统之间双向运动的概念。因此，我们在一项对因 COVID-19 住院的患者进行的新型前瞻性研究中，探索了胃食管反流病 (GORD) 微吸入和气液消化病理生理学的可能性。
这是一项对 210 例确诊为 COVID-19 的住院患者进行的前瞻性描述性队列研究。该队列根据症状严重程度和影像学结果分为三组患者。反流症状指数 (RSI) 用于评估 GOR 的存在和严重程度。RSI 大于 13 被认为是异常的。使用酶联免疫吸附试验 (ELISA) 检测患者唾液样本中的唾液胃蛋白酶水平。
共有 210 例 COVID-19 患者入组研究，其中 55.2% (116/210) 为轻症，31.9% (67/210) 为中度，12.9% (27/210) 为重症。34% (72/210) 的患者 RSI 评分超过 13，唾液胃蛋白酶中位数为 54±29ng/ml，表明大约三分之一的患者存在食管外反流 (EOR)。存在呼吸合并症、RSI 评分超过 13 和唾液胃蛋白酶水平>76ng/ml 会增加发生更严重 COVID-19 感染的风险。
该研究显示研究队列中 EOR 的患病率很高，并提供了首个前瞻性证据，表明 COVID-19 疾病中存在气液消化病理生理学，包括微吸入的可能性。我们认为，我们的研究结果支持进行更广泛的研究。
