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      Role of Saliva in Esophageal Defense: Implications in Patients With Nonerosive Reflux Disease

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          Abstract:

          Background:

          It has been previously demonstrated that patients with reflux esophagitis exhibit a significant impairment in the secretion of salivary protective components versus controls. However, the secretion of salivary protective factors in patients with nonerosive reflux disease (NERD) is not explored. The authors therefore studied the secretion of salivary volume, pH, bicarbonate, nonbicarbonate glycoconjugate, protein, epidermal growth factor (EGF), transforming growth factor alpha (TGF-α) and prostaglandin E2 in patients with NERD and compared with the corresponding values in controls (CTRL).

          Methods:

          Salivary secretion was collected during basal condition, mastication and intraesophageal mechanical (tubing, balloon) and chemical (initial saline, acid, acid/pepsin, final saline) stimulations, respectively, mimicking the natural gastroesophageal reflux.

          Results:

          Salivary volume, protein and TGF-α outputs in patients with NERD were significantly higher than CTRL during intraesophageal mechanical ( P < 0.05) and chemical stimulations ( P < 0.05). Salivary bicarbonate was significantly higher in NERD than CTRL group during intraesophageal stimulation with both acid/pepsin ( P < 0.05) and saline ( P < 0.01). Salivary glycoconjugate secretion was significantly higher in the NERD group than the CTRL group during chewing ( P < 0.05), mechanical ( P < 0.05) and chemical stimulation ( P < 0.01). Salivary EGF secretion was higher in patients with NERD during mechanical stimulation ( P < 0.05).

          Conclusions:

          Patients with NERD demonstrated a significantly stronger salivary secretory response in terms of volume, bicarbonate, glycoconjugate, protein, EGF and TGF-α than asymptomatic controls. This enhanced salivary esophagoprotection is potentially mediating resistance to the development of endoscopic mucosal changes by gastroesophageal reflux.

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          Epidemiology of gastro-oesophageal reflux disease: a systematic review.

          J. Dent, H B El-Serag, M.-A. Wallander … (2005)
          A systematic review of the epidemiology of gastro-oesophageal reflux disease (GORD) has been performed, applying strict criteria for quality of studies and the disease definition used. The prevalence and incidence of GORD was estimated from 15 studies which defined GORD as at least weekly heartburn and/or acid regurgitation and met criteria concerning sample size, response rate, and recall period. Data on factors associated with GORD were also evaluated. An approximate prevalence of 10-20% was identified for GORD, defined by at least weekly heartburn and/or acid regurgitation in the Western world while in Asia this was lower, at less than 5%. The incidence in the Western world was approximately 5 per 1000 person years. A number of potential risk factors (for example, an immediate family history and obesity) and comorbidities (for example, respiratory diseases and chest pain) associated with GORD were identified. Data reported in this systematic review can be interpreted with confidence as reflecting the epidemiology of "true" GORD. The disease is more common in the Western world than in Asia, and the low rate of incidence relative to prevalence reflects its chronicity. The small number of studies eligible for inclusion in this review highlights the need for global consensus on a symptom based definition of GORD.
          Article 0 comments Cited 363 times – based on 0 reviews     Review now
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            High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: a Kalixanda study report.

            Michael Vieth, T Storskrubb, Nicholas J. Talley … (2005)
            Gastroesophageal reflux disease has been reported to be a common burden on health-care resources in the Western world, but its manifestations in the general population are as yet unclear. The aim of this study was to estimate the prevalence of, and to identify the risk factors for gastroesophageal reflux symptoms (GERS) and erosive esophagitis (EE) in the adult population of two Swedish municipalities. A random sample (n =3000) of the adult population (20-81 years of age) of two Swedish municipalities (n =21,610) was surveyed using a validated postal questionnaire assessing gastrointestinal symptoms. The response rate was 74%. A subsample (n = 1000) of the responders was subsequently invited, in random order, for esophago-gastro-duodenoscopy with evaluation of GERS, risk factors and tests for Helicobacter pylori. GERS were reported by 40.0% and EE was found in 15.5% of the population that had undergone endoscopy. Of those with GERS, 24.5% had EE while 36.8% of those with EE reported no GERS. Hiatus hernia and obesity remained significant risk factors for GERS and/or EE, with or without symptoms in a main effect model (OR up to 14 at EE). Those with active H. pylori infection had a higher risk of GERS without EE than those without H. pylori infection (OR = 1.71 (1.23 2.38)). GERS and EE (of which one-third is asymptomatic) are highly prevalent in the Swedish adult population. H. pylori infection seems to play a role in the manifestations of gastroesophageal reflux.
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              Prevalence and socioeconomic impact of upper gastrointestinal disorders in the United States: results of the US Upper Gastrointestinal Study.

              Vincenzo Stanghellini, Dominique Dubois, Amnon Sonnenberg … (2005)
              This study examined the prevalence of upper gastrointestinal (GI) symptoms and symptom groupings and determined impact on disability days in a nationally representative US sample. A telephone survey of 21,128 adults was conducted including questions about the presence of upper GI symptoms during the past 3 months. Respondents were categorized as symptomatic (ie, reported GI symptoms once per month) or asymptomatic. The survey included questions about missed work, leisure activity, or household activity days. Symptom groupings were identified by using factor analysis, and cluster analysis was used to assign respondents into distinct groups on the basis of these symptom groupings. The prevalence of an average of 1 or more upper GI symptoms during the past 3 months was 44.9%. The most common symptoms experienced during the past 3 months were early satiety, heartburn, and postprandial fullness. Factor analysis identified 4 symptom groupings: (1) heartburn/regurgitation; (2) nausea/vomiting; (3) bloating/abdominal pain; and (4) early satiety/loss of appetite. Five respondent clusters were identified; the largest clusters were primarily early satiety/fullness (44%) and gastroesophageal reflux disease-like symptoms (28%). Two small clusters reflected nausea and vomiting (7%) and a heterogeneous symptom profile (4%). Symptomatic respondents reported significantly more missed work, leisure, and household activity days than asymptomatic respondents (all P < .0001). Factor analysis separated GI symptoms into groupings reflecting gastroesophageal reflux disease and dyspepsia: early satiety, postprandial fullness, and loss of appetite; bloating and abdominal pain/discomfort; and nausea and vomiting. These upper GI symptoms were associated with significant loss of work and activity days.
              Article 0 comments Cited 83 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Am J Med Sci
                Journal ID (iso-abbrev): Am. J. Med. Sci
                Journal ID (publisher-id): maj
                Title: The American Journal of the Medical Sciences
                Publisher: The American Journal of the Medical Sciences
                ISSN (Print): 0002-9629
                ISSN (Electronic): 1538-2990
                Publication date (Print): May 2015
                Publication date (Electronic): 29 April 2015
                Volume: 349
                Issue: 5
                Pages: 385-391
                Affiliations
                Molecular Medicine Research Laboratory ( hy, mm, kh, gg, is, js), Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas; Nicolaus Copernicus University of Torun ( cp), Torun, Poland; University of Virginia Health Sciences Center (KH, GG), Charlottesville, VA; and Medical University of Bialystok ( tz, zn), Bialystok, Poland.
                Author notes
                Correspondence: Jerzy Sarosiek, MD, PhD, Molecular Medicine Research Laboratory, Department of Internal Medicine, Internal Medicine Research Committee, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79905 (E-mail: jerzy.sarosiek@ 123456ttuhsc.edu ).
                Article
                Publisher ID: MAJ14-440 Accession ID: 00002
                DOI: 10.1097/MAJ.0000000000000443
                PMC ID: 4418785
                PubMed ID: 25789686
                SO-VID: 5bf59e9a-abd7-4d92-87e2-6021070f4d1f
                Copyright © Copyright © 2015 by the Southern Society for Clinical Investigation.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

                History
                Date received : 29 July 2014
                Date accepted : 20 January 2015
                Categories
                Subject: Clinical Investigation
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: nonerosive reflux disease,salivary protection,bicarbonate,glycoconjugate,epidermal growth factor
                Data availability:
                Keywords: nonerosive reflux disease, salivary protection, bicarbonate, glycoconjugate, epidermal growth factor

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