Increased esophageal mucosal/submucosal blood flow in patients with gastroesophageal reflux disease: Normalization by treatment with a proton pump inhibitor

Mine, Shinichiro; Iida, Takeshi; Tabata, Toshiharu; Okada, Yosuke; Tanaka, Yoshiya

doi:10.1111/j.1440-1746.2007.05113.x

Cited by 5 publications

(5 citation statements)

References 31 publications

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“…Magnified and image-enhanced endoscopy also revealed the presence of inflammatory changes in the macroscopically normal esophageal mucosa of reflux patients [29], [32], [33]. Furthermore, endoscopic ultrasound has demonstrated increased thickness and blood flow in the esophageal mucosa and submucosa, suggesting inflammation in the entire wall of the lower esophagus in both erosive and non-erosive reflux disease [34]. These and our findings may provide clues to explain the broad spectrum of manifestations and unpredictable therapeutic responses in patients with GERD [30].…”

Section: Discussionmentioning

confidence: 99%

Association of Esophageal Inflammation, Obesity and Gastroesophageal Reflux Disease: From FDG PET/CT Perspective

Tseng

Lee

et al. 2014

PLoS ONE

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ObjectiveGastroesophageal reflux disease (GERD) is associated with bothersome symptoms and neoplastic progression into Barrett's esophagus and esophageal adenocarcinoma. We aim to determine the correlation between GERD, esophageal inflammation and obesity with 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT).MethodsWe studied 458 subjects who underwent a comprehensive health check-up, which included an upper gastrointestinal endoscopy, FDG PET/CT and complete anthropometric measures. GERD symptoms were evaluated with Reflux Disease Questionnaire. Endoscopically erosive esophagitis was scored using the Los Angeles classification system. Inflammatory activity, represented by standardized uptake values (SUVmax) of FDG at pre-determined locations of esophagus, stomach and duodenum, were compared. Association between erosive esophagitis, FDG activity and anthropometric evaluation, including body mass index (BMI), waist circumference, visceral and subcutaneous adipose tissue volumes were analyzed.ResultsSubjects with erosive esophagitis (n = 178, 38.9%) had significantly higher SUVmax at middle esophagus (2.69±0.74 vs. 2.41±0.57, P<.001) and esophagogastric junction (3.10±0.89 vs. 2.38±0.57, P<.001), marginally higher at upper esophageal sphincter (2.29±0.42 vs. 2.21±0.48, P = .062), but not in stomach or duodenum. The severity of erosive esophagitis correlated with SUVmax and subjects with Barrett's esophagus had the highest SUVmax at middle esophagus and esophagogastric junction. Heartburn positively correlated with higher SUVmax at middle oesophagus (r = .262, P = .003). Using multivariate regression analyses, age (P = .027), total cholesterol level (P = .003), alcohol drinking (P = .03), subcutaneous adipose tissue (P<.001), BMI (P<.001) and waist circumference (P<.001) were independently associated with higher SUVmax at respective esophageal locations.ConclusionsEsophageal inflammation demonstrated by FDG PET/CT correlates with endoscopic findings and symptomatology of GERD. Obesity markers, both visceral and general, are independent determinants of esophageal inflammation.

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Section: Discussionmentioning

confidence: 99%

Association of Esophageal Inflammation, Obesity and Gastroesophageal Reflux Disease: From FDG PET/CT Perspective

Tseng

Lee

et al. 2014

PLoS ONE

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“…Interestingly, the extent and depth of mucosal damage depends on the time and degree of complete cessation or reduction of EBF. The regulation of EBF depends on systemic nervous mechanisms and local hormonal-humoral factors [ 21 , 22 , 23 , 24 , 25 ]. Under physiological conditions, the EBF increases in response to increased secretory activity of the esophageal mucosa and during incidental acid reflux episodes of gastric content [ 23 , 24 , 25 ].…”

Section: Anti-reflux Esophageal Barrier and Pathogenesis Of Esophamentioning

confidence: 99%

“…The regulation of EBF depends on systemic nervous mechanisms and local hormonal-humoral factors [ 21 , 22 , 23 , 24 , 25 ]. Under physiological conditions, the EBF increases in response to increased secretory activity of the esophageal mucosa and during incidental acid reflux episodes of gastric content [ 23 , 24 , 25 ]. This local hyperemia is responsible for the bicarbonate supply which creates and maintains the alkaline pH of the mucous membrane surface and provides rapid neutralization of the acid load during reflux episodes [ 20 , 24 , 25 ].…”

Section: Anti-reflux Esophageal Barrier and Pathogenesis Of Esophamentioning

confidence: 99%

Melatonin in Prevention of the Sequence from Reflux Esophagitis to Barrett’s Esophagus and Esophageal Adenocarcinoma: Experimental and Clinical Perspectives

Majka

Wierdak

Brzozowska

et al. 2018

IJMS

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Melatonin is a tryptophan-derived molecule with pleiotropic activities which is produced in all living organisms. This “sleep” hormone is a free radical scavenger, which activates several anti-oxidative enzymes and mechanisms. Melatonin, a highly lipophilic hormone, can reach body target cells rapidly, acting as the circadian signal to alter numerous physiological functions in the body. This indoleamine can protect the organs against a variety of damaging agents via multiple signaling. This review focused on the role played by melatonin in the mechanism of esophagoprotection, starting with its short-term protection against acute reflux esophagitis and then investigating the long-term prevention of chronic inflammation that leads to gastroesophageal reflux disease (GERD) and Barrett’s esophagus. Since both of these condition are also identified as major risk factors for esophageal carcinoma, we provide some experimental and clinical evidence that supplementation therapy with melatonin could be useful in esophageal injury by protecting various animal models and patients with GERD from erosions, Barrett’s esophagus and neoplasia. The physiological aspects of the synthesis and release of this indoleamine in the gut, including its release into portal circulation and liver uptake is examined. The beneficial influence of melatonin in preventing esophageal injury from acid-pepsin and acid-pepsin-bile exposure in animals as well as the usefulness of melatonin and its precursor, L-tryptophan in prophylactic and supplementary therapy against esophageal disorders in humans, are also discussed.

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“…Although by definition patients with NERD have macroscopically normal esophageal mucosa, such patients may have functional and/or microscopic mucosal abnormalities. 35 For instance, Mine et al 36 demonstrated in GERD patients with erosive esophagitis an increase in esophageal mucosal blood flow, as assessed by laser Doppler flowmetry, which can be normalized following proton pump inhibition. The esophageal mucosal barrier is a central, protective facet of the mechanisms that protect against the deleterious effects of the gastroesophageal refluxate.…”

Section: Mucosal Barriersmentioning

confidence: 99%

“…Objective tool to identify differences between GERD patients and healthy controls with regard to EGJ compliance. Mucosal barriers [35][36][37][38] Microscopic mucosal abnormalities using ultrastructural scanning techniques, dilated intracellular spaces in patients with NERD. In vitro: transepithelial electrical resistance of the esophageal mucosa to the passage of small molecules can be evaluated using Ussing chambers.…”

Section: Electrophysiologymentioning

confidence: 99%

Neurophysiology and new techniques to assess esophageal sensory function: an update

Brock

McCallum

Gyawali

et al. 2016

Annals of the New York Academy of Sciences

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This review aims to discuss the neurophysiology of the esophagus and new methods to assess esophageal nociception. Pain and other symptoms can be caused by diseases in the mucosa or muscular or sphincter dysfunction, together with abnormal pain processing, either in the peripheral or central nervous systems. Therefore, we present new techniques in the assessment of esophageal function and the potential role of the mucosal barrier in the generation and propagation of pain. We discuss the assessment and role of esophageal sphincters in nociception, as well as imaging and electrophysiological techniques, with examples of their use in understanding the sensory system following noxious stimuli to the esophagus. Additionally, we discuss the mechanisms behind functional diseases of the esophagus. We conclude that the new methods have identified many of the mechanisms behind malfunction of the mucosa, disturbances of muscular and sphincter functions, and the central response to different stimuli. Taken together, this has increased our understanding of esophageal disorders and may lead to new treatment modalities.

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Increased esophageal mucosal/submucosal blood flow in patients with gastroesophageal reflux disease: Normalization by treatment with a proton pump inhibitor

Cited by 5 publications

References 31 publications

Association of Esophageal Inflammation, Obesity and Gastroesophageal Reflux Disease: From FDG PET/CT Perspective

Association of Esophageal Inflammation, Obesity and Gastroesophageal Reflux Disease: From FDG PET/CT Perspective

Melatonin in Prevention of the Sequence from Reflux Esophagitis to Barrett’s Esophagus and Esophageal Adenocarcinoma: Experimental and Clinical Perspectives

Neurophysiology and new techniques to assess esophageal sensory function: an update

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