Relationship Between Salivary Pepsin Concentration and Esophageal Mucosal Integrity in Patients With Gastroesophageal Reflux Disease

Abstract

Background/AimsIncreased 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. MethodsA 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. ResultsThe 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 (r = 0.669, P = 0.035). ConclusionsWe 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.

Dichloromethane Extracts of Geranium Koreanum Kom. Alleviates Esophagus Damage in Acute Reflux Esophagitis-Induced Rats by Anti-Inflammatory Activities

“…Esophageal mucosal damage is caused by the reflux of gastric acid and stomach contents, which is related to the inflammation process and might lead to esophageal stenosis and cancer in the esophagus [ 3 , 32 ]. To evaluate the protective effects of DGK on RE rats, experimental rats were orally administrated with DICHO fraction (100 and 200 mg/kg body weight).…”

Validation in China of a non‐invasive salivary pepsin biomarker containing two unique human pepsin monoclonal antibodies to diagnose gastroesophageal reflux disease

“…Pepsin is the key aggressive enzyme in the gastric juice and is a vital biomarker used in the diagnosis of GERD …”

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders

“…51 Previous studies have shown that esophageal and throat tissues were sensitive to pepsin, and a small amount of activated pepsin could cause inflammation in the mucosa of the esophagus and throat, thus causing subjective discomfort and symptoms. [52][53][54] A previous study by Li et al 55 showed that the intercellular spaces measurements were greater in EE and NERD groups than in FH and HC groups. Patients with NERD had a higher level of salivary pepsin compared to those with FH.…”