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Filho FDSA, Santiago LH, Fernandes ACN, Korn GP, Pontes PADL, Camponês do Brasil ODO. Preliminary Correlation of the Immunoexpression of Cathepsin B and E-Cadherin Proteins in Vocal Fold Leukoplakia. J Voice 2024; 38:760-767. [PMID: 34663533 DOI: 10.1016/j.jvoice.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Early identification of vocal fold leukoplakia (VFL), which has a risk of progressing to malignant transformation, remains a controversial topic. The identification of biological markers for diagnosing these lesions would lead to a more effective treatment. We aimed to analyze the immunoexpression of cathepsin B and E-cadherin in VFL and correlate it with clinical and epidemiological data and disease prognosis. METHODS Thirty-two patients with VFL treated with microsurgery were retrospectively evaluated. The patients were distributed according to the histological results into Group A (low grade) and Group B (high grade). The expression of markers was quantitatively determined as per their staining intensity and tissue distribution using ImageLab. The index of expression (IE) of each marker was correlated with tobacco and alcohol consumption, signs of laryngopharyngeal reflux, and local recurrence of the lesion. RESULTS The correlation between the IE of markers and variables within the two groups (A and B) demonstrated that patients in Group B with local recurrence had a higher IE of cathepsin B. When all patients (A + B) were included, the same analysis demonstrated that the IE of cathepsin B was higher among smokers and patients who did not show signs of reflux and that the IE of E-cadherin was higher only in patients with recurrence. CONCLUSION Patients with moderate to severe dysplasia and carcinoma in situ who smoked as well as had a high IE of cathepsin B were more prone to local recurrence. Regardless of the type of histological lesion, patients with signs of laryngopharyngeal reflux had a lower IE of cathepsin B. The IE of E-cadherin was higher among patients with VFL who relapsed after initial treatment.
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Affiliation(s)
- Francisco de Souza Amorim Filho
- Department of Otolaryngology, Head and Neck Surgery of the Federal University of São Paulo, Paulista School of Medicine, São Paulo, Brazil
| | | | - Ana Carolina Nascimento Fernandes
- Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Faculdade de Medicina, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília/DF, Brazil.
| | - Gustavo Polacow Korn
- Department of Otolaryngology and Head, Neck Surgery of the Federal University of São Paulo, Paulista School of Medicine, São Paulo, Brazil
| | - Paulo Augusto de Lima Pontes
- Department of Otolaryngology, Head and Neck Surgery of the Federal University of São Paulo, Paulista Medical School, São Paulo, Brazil
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Ku PKM, Vlantis AC, Hui TSC, Yeung ZWC, Cho RHW, Wong MHK, Lee AKF, Yeung DCM, Chan SYP, Chan BYT, Chang WT, Mok F, Wong KH, Wong JKT, Abdullah V, van Hasselt A, Wu JCY, Tong MCF. The prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux in patients with dysphagia after radiotherapy for nasopharyngeal carcinoma. Head Neck 2024. [PMID: 38235957 DOI: 10.1002/hed.27645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/05/2023] [Accepted: 01/09/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The prevalence of gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) in post-irradiated patients with nasopharyngeal carcinoma (NPC) is unknown. MATERIALS AND METHODS In a cross-sectional study, 31 NPC and 12 control patients completed questionnaires for GERD/LPR before esophageal manometry and 24-h pH monitoring. The DeMeester score and reflux finding score (RFS) were used to define GERD and LPR, respectively. Risk factors were identified. RESULTS 51.6% of NPC and 8.3% of control patients, and 77.4% of NPC and 33% of control patients, were GERD-positive and LPR-positive, respectively. The GERD/LPR questionnaire failed to identify either condition in patients with NPC. No parameter differences in esophageal manometry or pneumonia incidence were noted between GERD/LPR-positive and GERD/LPR-negative patients. Post radiotherapy duration, high BMI, lack of chemotherapy, and dysphagia were positive risk factors for GERD/LPR. CONCLUSIONS A high prevalence of GERD/LPR in patients with post-irradiated NPC exists, but reflux symptoms are inadequate for diagnosis.
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Affiliation(s)
- Peter K M Ku
- Department of Otorhinolaryngology - Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Department of Otorhinolaryngology - Head and Neck Surgery, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong, China
| | - Alexander C Vlantis
- Department of Otorhinolaryngology - Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Thomas S C Hui
- Department of Otorhinolaryngology - Head and Neck Surgery, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong, China
| | - Zenon W C Yeung
- Department of Otorhinolaryngology - Head and Neck Surgery, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong, China
| | - Ryan H W Cho
- Department of Otorhinolaryngology - Head and Neck Surgery, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong, China
| | - Marc H K Wong
- Department of Gastroenterology and Hepatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Alex K F Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong, China
| | - David C M Yeung
- Department of Otorhinolaryngology - Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Simon Y P Chan
- Department of Speech Therapy, Prince of Wales Hospital, Hong Kong, China
| | - Becky Y T Chan
- Department of Speech Therapy, Prince of Wales Hospital, Hong Kong, China
| | - Wai-Tsz Chang
- Department of Otorhinolaryngology - Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Florence Mok
- Department of Clinical Oncology and Radiotherapy, Prince of Wales Hospital, Hong Kong, China
| | - Kam-Hung Wong
- Department of Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Jeffrey K T Wong
- Department of Imaging and Interventional Radiotherapy, Prince of Wales Hospital, Hong Kong, China
| | - Victor Abdullah
- Department of Otorhinolaryngology - Head and Neck Surgery, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong, China
| | - Andrew van Hasselt
- Department of Otorhinolaryngology - Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Justin C Y Wu
- Department of Gastroenterology and Hepatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Michael C F Tong
- Department of Otorhinolaryngology - Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Gregor JW, Watts SA. Implementation of Esophageal Screening in an Outpatient Hospital-Based Setting: A Quality Improvement Project. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2603-2614. [PMID: 37722389 DOI: 10.1044/2023_ajslp-23-00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
PURPOSE Despite evidence supporting interconnectivity of oropharyngeal and esophageal swallowing, evaluation and treatment are dichotomized. When the videofluoroscopic swallowing study (VFSS) only considers oropharyngeal swallowing, the full scope of swallowing impairment may be missed. A lower rate of esophageal screening in an outpatient hospital setting may result from lack of speech-language pathologist (SLP) training and understanding of screening feasibility. This project was an internal quality improvement project (QIP) at Mayo Clinic in Arizona to (a) educate and train SLPs on conducting the Robust Esophageal Screening Test (REST) and (b) determine the feasibility of REST protocol implementation in a multidisciplinary swallow clinic. METHOD Fishbone analysis was used to identify potential causes of the gap in quality. Six Sigma methodology was used to outline the QIP. SLPs were trained in the REST protocol. To ensure adequate training, reliability ratings were assessed with the Cohen's kappa statistic. Esophageal screening via REST was implemented as an adjunct to the standard protocol during VFSS over a 3-month period for referred patients with dysphagia. Clinical findings were recorded. RESULTS All clinical rater SLPs reached the threshold of κ = .8 to ensure adequate rater reliability. Among 136 outpatients who underwent esophageal screening via REST, 100 patients completed the full REST screening and 36 completed a partial REST screening. Of the 100 full screenings, 80 patients had a failed screening, which indicated a potential esophageal swallowing impairment. Findings were discussed by members of the multidisciplinary dysphagia care team. CONCLUSIONS The results of this QIP show that focusing on assessment of dysfunction and interplay across the swallowing continuum can substantially improve patient care by expediting and specifying next steps of the multidisciplinary dysphagia care team.
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Affiliation(s)
- Jessica W Gregor
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Phoenix, AZ
| | - Stephanie A Watts
- Department of Otolaryngology-Head and Neck Surgery, Morsani College of Medicine, Tampa, FL
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Ananthapadmanabhan S, Jabbour J, Lai S, Suruliraj A, Smith M, Riffat F, Devadas M, Liem H, Sritharan N. A Multidisciplinary Approach to Secondary Tracheoesophageal Puncture for Voice Prosthesis Insertion Using Flexible Esophagoscopy. J Voice 2022:S0892-1997(22)00076-5. [PMID: 35418350 DOI: 10.1016/j.jvoice.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tracheoesophageal puncture (TEP) with voice prosthesis (VP) insertion is the gold standard of surgical voice restoration in postlaryngectomy patients. The conventional technique involves rigid esophagoscopes and trocar performed by ENT surgeons alone, with technical limitations encountered in patients with cervical abnormalities - in particular those with free or rotational flap reconstructions and postradiotherapy strictures. We report our technique using flexible endoscopy which we show to be feasible and without major safety events, as a possible consideration in the anticipated difficult TEP. METHODS Our study describes a multidisciplinary approach to secondary TEP involving a combined upper gastrointestinal (UGI) and (Ear, Nose, and Throat) ENT procedure, under the guidance of flexible esophagoscopy, with intraoperative involvement of the speech pathologist to guide VP insertion and placement. The procedure was performed with ease without major complications. RESULTS We identified nine postlaryngectomy and laryngopharyngectomy patients in our institution who underwent secondary TEP with VP insertion using flexible esophagoscopy and multidisciplinary intra-operative involvement. All patients had pharyngeal reconstruction, including radial forearm free flap (n = 4), pectoralis major rotational flap (n = 3), and anterolateral thigh flap (n = 2). Eight out of nine patients underwent adjuvant radiotherapy. The technique was successfully performed in all patients. There were three cases of early TEP displacement in two patients, of which one patient had a successful repeat procedure. We found the technique advantageous in terms of feasibility and practicality compared to the conventional approach, and without intraoperative difficulties encountered in achieving the desired field of views or navigating the challenging anatomy in a free flap and post-radiotherapy patients. This includes distorted cervical anatomy, the presence of bulky and hair-bearing flap skin, and stricture formation. Minor complications in our cohort included pharyngo-esophageal spasm, TEP displacement, granulation tissue, and peri-prosthetic leaks. CONCLUSION Our multidisciplinary approach to secondary TEP was performed with flexible esophagoscopy without major related complications. The technique is advantageous in the surgical approach to VP insertion in postlaryngectomy and laryngopharyngectomy patients who have had radiotherapy or pharyngeal reconstruction. It allows for safe anatomical insertion and thorough evaluation of the upper aerodigestive tract for comorbid benign or malignant esophageal pathology.
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Affiliation(s)
| | - Joe Jabbour
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Stephanie Lai
- Department of Speech Pathology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Anand Suruliraj
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Mark Smith
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Michael Devadas
- Department of Upper GI Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Han Liem
- Department of Upper GI Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Niranjan Sritharan
- Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia
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Yin Y, Li H, Feng J, Zheng K, Yoshida E, Wang L, Wu Y, Guo X, Shao X, Qi X. Prevalence and Clinical and Endoscopic Characteristics of Cervical Inlet Patch (Heterotopic Gastric Mucosa): A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2022; 56:e250-e262. [PMID: 33780217 DOI: 10.1097/mcg.0000000000001516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cervical inlet patch (CIP), also called gastric inlet patch, is a heterotopic columnar mucosal island located in the cervical esophagus, which has been under-recognized by clinicians. AIM We conducted a systemic review and meta-analysis to explore the prevalence and clinical and endoscopic characteristics of CIP. MATERIALS AND METHODS Studies were searched through the PubMed, EMBASE, and Cochrane Library databases. The prevalence of CIP with 95% confidence interval (CI) was pooled by using a random-effect model. The association of CIP with demographics, clinical presentations, and endoscopic features was evaluated by odds ratios (ORs). RESULTS Fifty-three studies including 932,777 patients were eligible. The pooled prevalence of CIP was 3.32% (95% CI=2.86%-3.82%). According to the endoscopic mode, the pooled prevalence of CIP was higher in studies using narrow-band imaging than in those using white light and esophageal capsule endoscopy (9.34% vs. 2.88% and 0.65%). The pooled prevalence of CIP was higher in studies where the endoscopists paid specific attention to the detection of this lesion (5.30% vs. 0.75%). CIP was significantly associated with male (OR=1.24, 95% CI=1.09-1.42, P=0.001), gastroesophageal reflux disease (OR=1.32, 95% CI=1.04-1.68, P=0.03), reflux symptoms (OR=1.44, 95% CI=1.14-1.83, P=0.002), dysphagia (OR=1.88, 95% CI=1.28-2.77, P=0.001), throat discomfort (OR=4.58, 95% CI=1.00-21.02, P=0.05), globus (OR=2.95, 95% CI=1.52-5.73, P=0.001), hoarseness (OR=4.32, 95% CI=1.91-9.78, P=0.0004), cough (OR=3.48, 95% CI=1.13-10.72, P=0.03), Barrett's esophagus (OR=2.01, 95% CI=1.37-2.94, P=0.0003), and esophagitis (OR=1.62, 95% CI=1.27-2.07, P=0.0001). CONCLUSION CIP appears to be common by using narrow-band imaging, especially if the endoscopists would like to pay attention to the detection of this lesion. CIP is clearly associated with acid-related symptoms and Barrett's esophagus.
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Affiliation(s)
- Yue Yin
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
- Postgraduate College, Jinzhou Medical University, Jinzhou
| | - Hongyu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
| | - Ji Feng
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
| | - Kexin Zheng
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
- Postgraduate College, Jinzhou Medical University, Jinzhou
| | - Eric Yoshida
- Department of Medicine, Division of Gastroenterology, Vancouver General Hospital, Vancouver, Canada
| | - Le Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
- Postgraduate College, Dalian Medical University, Dalian, People's Republic of China
| | - Yanyan Wu
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
- Postgraduate College, Jinzhou Medical University, Jinzhou
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
| | - Xiaodong Shao
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang
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Doukas PG, Vageli DP, Sasaki CT, Judson BL. Pepsin Promotes Activation of Epidermal Growth Factor Receptor and Downstream Oncogenic Pathways, at Slightly Acidic and Neutral pH, in Exposed Hypopharyngeal Cells. Int J Mol Sci 2021; 22:ijms22084275. [PMID: 33924087 PMCID: PMC8074291 DOI: 10.3390/ijms22084275] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 02/07/2023] Open
Abstract
Pepsin refluxate is considered a risk factor for laryngopharyngeal carcinogenesis. Non-acidic pepsin was previously linked to an inflammatory and tumorigenic effect on laryngopharyngeal cells in vitro. Yet there is no clear evidence of the pepsin-effect on a specific oncogenic pathway and the importance of pH in this process. We hypothesized that less acidic pepsin triggers the activation of a specific oncogenic factor and related-signalling pathway. To explore the pepsin-effect in vitro, we performed intermittent exposure of 15 min, once per day, for a 5-day period, of human hypopharyngeal primary cells (HCs) to pepsin (1 mg/mL), at a weakly acidic pH of 5.0, a slightly acidic pH of 6.0, and a neutral pH of 7.0. We have documented that the extracellular environment at pH 6.0, and particularly pH 7.0, vs. pH 5.0, promotes the pepsin-effect on HCs, causing increased internalized pepsin and cell viability, a pronounced activation of EGFR accompanied by NF-κB and STAT3 activation, and a significant upregulation of EGFR, AKT1, mTOR, IL1β, TNF-α, RELA(p65), BCL-2, IL6 and STAT3. We herein provide new evidence of the pepsin-effect on oncogenic EGFR activation and its related-signaling pathway at neutral and slightly acidic pH in HCs, opening a window to further explore the prevention and therapeutic approach of laryngopharyngeal reflux disease.
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Gu W, Niu YY, Wang WZ, Liang ZY, Jin XF, Huo H, Wang J. Analysis of reflux as the aetiology of laryngeal dysplasia progression through a matched case-control study. Clin Otolaryngol 2020; 46:175-180. [PMID: 32871030 DOI: 10.1111/coa.13638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/11/2020] [Accepted: 08/16/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Laryngeal dysplasia (LD) is a precancerous lesion of the larynx. In this study, the laryngeal tissue of patients with laryngeal dysplasia was taken as the research object, and the aetiology of reflux was analysed. METHOD Patients with laryngeal dysplasia after surgery were selected as our subjects. The levels of pepsin, enterokinase and bilirubin in laryngeal tissue samples of the two groups were detected by immunohistochemical method. RESULTS The OR values (95% CI) of pepsin, enterokinase and bilirubin were 0.67 (0.19-2.36), 0.80 (0.22-2.98) and 1.33 (0.30-5.96), respectively, in the univariate analysis. Besides, in the multivariate analysis, the OR values (95% CI) of pepsin, enterokinase and bilirubin were 0.57 (0.14-2.30), 0.73 (0.18-2.92) and 1.40 (0.30-6.53), respectively. CONCLUSION Larger sample size should be applied to prospective studies on whether reflux is a risk factor for laryngeal cancer.
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Affiliation(s)
- Wei Gu
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan-Yan Niu
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Ze Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Yong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Feng Jin
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Huo
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Wang
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yin CY, Zhang SS, Zhong JT, Zhou SH. Pepsin and Laryngeal and Hypopharyngeal Carcinomas. Clin Exp Otorhinolaryngol 2020; 14:159-168. [PMID: 32734742 PMCID: PMC8111387 DOI: 10.21053/ceo.2020.00465] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/17/2020] [Indexed: 02/08/2023] Open
Abstract
Laryngeal and hypopharyngeal carcinomas are common malignant tumors of the head and neck, and the incidence of both is increasing. Laryngopharyngeal reflux refers to the retrograde flow of gastric contents into the larynx, oropharynx, and/or nasopharynx. It remains controversial whether laryngopharyngeal reflux is a risk factor for laryngeal and hypopharyngeal cancers. The refluxing substances mainly include hydrochloric acid, pepsin, and occasionally bile acids and bile salts, as well as bacteria that colonize the gastrointestinal tract. Loss of epithelium in the mucous membrane of the larynx and hypopharynx is thought to be caused by pepsin. Here, we review the relationships between laryngopharyngeal reflux and both laryngeal and hypopharyngeal carcinomas, as well as the significance of pepsin, methods of clinical detection, and the mechanism of carcinogenesis.
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Affiliation(s)
- Cheng-Yi Yin
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Otolaryngology, The First People's Hospital of Huzhou City, Zhejiang, China
| | - Sha-Sha Zhang
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jiang-Tao Zhong
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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The prevalence of signs and symptoms of laryngopharyngeal reflux and laryngeal precancerous lesions in urban taxi drivers. Eur Arch Otorhinolaryngol 2020; 277:2285-2291. [DOI: 10.1007/s00405-020-05983-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
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10
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Cao J, Zhang L, Liu YJ, Wang WL, Wang YG, Li CF, Zhao YX, Li SL, Yu LS. Properties of a Novel Animal Model of LPR. J Voice 2020; 35:805.e17-805.e26. [PMID: 32081507 DOI: 10.1016/j.jvoice.2020.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Few satisfactory animal models of laryngopharyngeal reflux (LPR) is available. Interleukin-8 (IL-8) and vascular endothelial growth factor (VEGF) may be associated with the pathogenesis of LPR injuries and laryngeal carcinomas. OBJECTIVES To establish an animal model of LPR and to explore the related pathological changes and cytokine expression in the vocal cord tissue. METHODS Twenty rabbits were divided into experimental and control groups. Dilatation of the upper and lower esophageal sphincter were carried out in the experimental group. The pH of the pharynx, pathological, and ultrastructural changes of the laryngeal tissue, and expression of IL-8 and VEGF were compared between the experimental group and controls. RESULTS pH monitoring results and the dilated intercellular space of the vocal cord mucosa showed that the experimental group developed laryngopharyngeal reflux. There were significant differences in the immunohistochemical staining scores of both IL-8 (P = 0.015) and VEGF (P = 0.007) between the experimental and control groups in the vocal cord tissue. CONCLUSIONS We successfully established a model of LPR, showing histopathological and ultrastructural changes consistent with the disease. The expression of IL-8 and VEGF may increase during the pathogenesis of LPR.
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Affiliation(s)
- Jie Cao
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's hospital, Peking University, Beijing, China
| | - Lihong Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's hospital, Peking University, Beijing, China
| | - Yuan-Jun Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's hospital, Peking University, Beijing, China
| | - Wen-Lun Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's hospital, Peking University, Beijing, China
| | - Yu-Guang Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's hospital, Peking University, Beijing, China
| | - Chao-Fan Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's hospital, Peking University, Beijing, China
| | - Yi-Xin Zhao
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's hospital, Peking University, Beijing, China
| | - Shuo-Lei Li
- Department of Experimental Animal Centre, Peking University People's Hospital, Peking University, Beijing, China
| | - Li-Sheng Yu
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's hospital, Peking University, Beijing, China.
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Tasli H, Eser B, Birkent H, Asik B, Gerek M. Investigation of Pepsin in Laryngeal Squamous Cell Carcinoma Specimens. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.661237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Kim JW, Kim HJ, Park KI, Kim YM, Choi JS. Association between salivary secretary function and laryngopharyngeal reflux: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:615-620.e1. [DOI: 10.1016/j.oooo.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/11/2019] [Accepted: 08/03/2019] [Indexed: 10/26/2022]
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He C, Yu J, Huang F, Shao J. The utility of narrow band imaging in endoscopic diagnosis of laryngopharyngeal reflux. Am J Otolaryngol 2019; 40:715-719. [PMID: 31280879 DOI: 10.1016/j.amjoto.2019.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/13/2019] [Accepted: 06/23/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study assessed the utility of narrow band imaging (NBI) in patients with symptoms of laryngopharyngeal reflux (LPR) and tried to quantitatively evaluate the signs found under the NBI Laryngoscope. METHODS Patients with and without LPR symptoms completed reflux symptom index (RSI) questionnaires prior to enrolment. The throat was examined by standard white light endoscopy followed by NBI. LPR status was determined using the reflux finding score and the RSI. Laryngoscope images and videos from 70 subjects with LPR and 70 control subjects without LPR were obtained. Features seen only by NBI were compared between the two groups. Then the RGB values of the throat mucosa of the two groups were measured by Photoshop software, and finally statistical analysis was performed. RESULTS In total, 140 patients were eligible for final analysis (LPR group mean age = 50.0, 47 males; control group mean age = 44.8, 45 males). A significantly higher proportion of patients with LPR had increased vascularity, green spots, contact ulcers and granulomas. Of these, increased vascularity and green spots can only be found under NBI, and the prevalence rates in the LPR group were found to be 92.8% and 88.6% (P < 0.05), respectively. In the control group, the prevalence rates of increased vascularity and green spots were 21.4% and 7.1%, respectively (P < 0.05). The RGB value of the LPR group was generally higher than that of the control group. The difference is statistically significant (P < 0.05). CONCLUSION LPR presents vascularity and green spots with high specificity and sensitivity under NBI which can play a role in the auxiliary diagnosis of LPR.
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Affiliation(s)
- Changding He
- Department of Otorhinolaryngology Head and Neck Surgery, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Jinchao Yu
- Department of Facial Plastic and Reconstructive Surgery, Eye & Ear Nose and Throat Hospital, Fudan University, Shanghai, PR China
| | - Fang Huang
- Department of Otorhinolaryngology Head and Neck Surgery, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Jun Shao
- Department of Otorhinolaryngology Head and Neck Surgery, Eye, Ear, Nose & Throat Hospital, Fudan University, Shanghai, PR China.
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Lorenz KJ, Grieser L, Ehrhart T, Maier H. Role of Reflux in Tracheoesophageal Fistula Problems after Laryngectomy. Ann Otol Rhinol Laryngol 2019. [DOI: 10.1177/000348941011901114] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives The purpose of this 2-year prospective nonrandomized study was to investigate the relationship between pathological supraesophageal reflux and the occurrence of speech fistula complications, especially severe fistula enlargement, in patients who underwent total laryngectomy and prosthetic voice restoration. Methods We objectively assessed the presence of reflux disease using 24-hour dual-probe pH monitoring in 60 laryngectomized patients, correlated the incidence of tracheoesophageal fistula complications with the severity of reflux, and assessed the risk of problems by determining the absolute number of reflux events at the level of the speech fistula, the reflux area index score, and the DeMeester score. Results All patients with fistula enlargement showed highly pathological results in the diagnostic tests for reflux disease. Depending on reflux severity, the relative risk of developing fistula complications was up to 10 times higher for these patients. Conclusions We found a significant correlation between the occurrence of tracheoesophageal fistula complications and the severity of supraesophageal reflux. Potential chronic irritation of the esophageal and tracheal mucosa can possibly contribute to the development of these problems. If the presence of reflux disease has been confirmed by 24-hour dual-probe pH monitoring, patients with fistula complications should be treated with proton pump inhibitors.
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Affiliation(s)
- Kai J. Lorenz
- Department of Otorhinolaryngology-Head and Neck
Surgery, German Armed Forces Hospital of Ulm, Ulm, Germany. Supported by Atos
Medical, Hörby, Sweden, and the German Ministry of Defense
| | - Laura Grieser
- Department of Otorhinolaryngology-Head and Neck
Surgery, German Armed Forces Hospital of Ulm, Ulm, Germany. Supported by Atos
Medical, Hörby, Sweden, and the German Ministry of Defense
| | - Theresa Ehrhart
- Department of Otorhinolaryngology-Head and Neck
Surgery, German Armed Forces Hospital of Ulm, Ulm, Germany. Supported by Atos
Medical, Hörby, Sweden, and the German Ministry of Defense
| | - Heinz Maier
- Department of Otorhinolaryngology-Head and Neck
Surgery, German Armed Forces Hospital of Ulm, Ulm, Germany. Supported by Atos
Medical, Hörby, Sweden, and the German Ministry of Defense
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A new approach to vocal cord leukoplakia and evaluation of proton pump ınhibitor treatment. Eur Arch Otorhinolaryngol 2019; 276:467-471. [DOI: 10.1007/s00405-018-05273-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 12/26/2018] [Indexed: 12/18/2022]
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Bacciu A, Mercante G, Ingegnoli A, Bacciu S, Ferri T. Reflux Esophagitis as a Possible Risk Factor in the Development of Pharyngolaryngeal Squamous Cell Carcinoma. TUMORI JOURNAL 2018; 89:485-7. [PMID: 14870768 DOI: 10.1177/030089160308900504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background To determine the role of reflux esophagitis in the development of pharyngolaryngeal squamous cell carcinoma in non-smoking and non-drinking patients. Methods The study population consisted of 92 consecutive non-smoking and non-drinking patients with histologically confirmed squamous cell carcinoma of the pharynx and the larynx. As a control, a group of 125 lifetime non-smoking and non-drinking cancer-free subjects was selected. Results Patients with pharyngolaryngeal cancer had a higher prevalence of reflux esophagitis than the control subjects (P <0.0001). Conclusions Our results confirm that reflux esophagitis in itself is associated with an increased risk of upper aerodigestive tract cancer.
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Affiliation(s)
- Andrea Bacciu
- Department of Otolaryngology, University of Parma, Italy.
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Gastro-pharyngeal reflux and total laryngectomy. Increasing knowledge about its management. Am J Otolaryngol 2018; 39:127-132. [PMID: 29307652 DOI: 10.1016/j.amjoto.2017.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE Investigate the incidence, the degree and the effect of gastro-pharyngeal reflux (GPR) in laryngectomised patients. MATERIALS AND METHODS Behavioral and 24-hour pH- and impedance-monitoring data were prospectively analyzed for 25 laryngectomised patients with no previous history of GER in outpateints' setting. Reflux detected was characterized as either acid, weakly acidic or nonacid. Proximal reflux was found at 15cm above the LES. RESULTS 40% of patients presented a pathological number of reflux episodes in the upright position (p<0.0001); 9 of them presented a pathologic bolus exposure time. Bolus exposure at the proximal sphincter was one fourth-fold lower than 5cm above the LES (p=0.3593). There was a prevalence of acid reflux at both sphincters (p<0.0001); liquid reflux was prevalent at the LES (p=0.003) and mixed reflux at the UES (p=0.0001). Median REs was higher than time acid exposure (p=0.0013). CONCLUSIONS Pre- and post-surgical reflux investigation could identify preexisting reflux severity and screen potential high-risk cancer patients for postoperative complications. This might allow the early onset of acid suppressive therapy in presence of pathologic findings in high-complication risk cancer patients.
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Jing Z, Xu H, Chen X, Zhong Q, Huang J, Zhang Y, Guo W, Yang Z, Ding S, Chen P, Huang Z. The Proton-Sensing G-Protein Coupled Receptor GPR4 Promotes Angiogenesis in Head and Neck Cancer. PLoS One 2016; 11:e0152789. [PMID: 27078157 PMCID: PMC4831743 DOI: 10.1371/journal.pone.0152789] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/18/2016] [Indexed: 11/18/2022] Open
Abstract
Squamous cell carcinoma of the head and neck (SCCHN) is an aggressive disease with poor survival and is the sixth most common cancer worldwide. Gastroesophageal reflux is a common event in SCCHN patients. GPR4 is a proton-sensing G-protein coupled receptor, which can be activated by acidosis. The objective of this study was to explore the role of GPR4 in acid exposure and tumor angiogenesis in SCCHN. In this study, we confirmed that overexpressing GPR4 in SCCHN cells could increase the expression and secretion of IL6, IL8 and VEGFA at pH 5.9. This effect could be inhibited by SB203580 (a p38 inhibitor). Western blot analysis indicated that phosphorylation of p38 increased in GPR4 infected cells at pH 5.9, which could be inhibited by SB203580. In tube formation assay, HMEC-1 cells were incubated with conditioned medium (CM, pH 5.9, 6.5, 7.4) derived from control and GPR4 infected SCCHN cells. Tube length was significantly increased in HMEC-1 cells incubated with CM from GPR4 infected cells compared with control cells at pH5.9, which indicated the pro-angiogenic effect of GPR4 in acidic pH. The neutralizing antibodies of IL6, IL8 and VEGFA could inhibit tube formation of HMEC-1 cells. In vivo, the effect of GPR4 on angiogenesis was investigated with the chick chorioallantoic membrane (CAM) model. Control and GPR4 infected SCCHN cells were seeded onto the upper CAM surface (n = 5 in each group) and 5 μL DMEM/F12 (pH 5.9, 6.5, 7.4) was added to the surface of the cell every 24 h. Four days later, the upper CAM were harvested and the ratio of the vascular area to the CAM area was quantified using Image-Pro Plus 6.0 software. GPR4 infected cells could recruit more vascular than control cells at pH5.9. In conclusion, we suggested that GPR4 induces angiogenesis via GPR4-induced p38-mediated IL6, IL8 and VEGFA secretion at acidic extracellular pH in SCCHN.
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Affiliation(s)
- Zhibin Jing
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongbo Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Chen
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qi Zhong
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Junwei Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Guo
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zheng Yang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shuo Ding
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ping Chen
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhigang Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- * E-mail:
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The Role of Pepsin in LPR: Will It Change Our Diagnostic and Therapeutic Approach to the Disease? CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0106-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Parzefall T, Wolf A, Czeiger S, Frei K, Formanek M, Erovic BM. Effect of postoperative use of diclofenac on pharyngocutaneous fistula development after primary total laryngopharyngectomy: Results of a single-center retrospective study. Head Neck 2015; 38 Suppl 1:E1515-20. [DOI: 10.1002/hed.24271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/13/2015] [Accepted: 09/13/2015] [Indexed: 12/26/2022] Open
Affiliation(s)
- Thomas Parzefall
- Department of Otolaryngology - Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Axel Wolf
- Department of Otolaryngology - Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Shelly Czeiger
- Department of Nuclear and Developmental Biology; Medical University of Vienna; Vienna Austria
| | - Klemens Frei
- Department of Otolaryngology - Head and Neck Surgery; Medical University of Vienna; Vienna Austria
| | - Michael Formanek
- Department of Otolaryngology - Head and Neck Surgery; Hospital of St. John of God; Vienna Austria
| | - Boban M. Erovic
- Department of Otolaryngology - Head and Neck Surgery; Medical University of Vienna; Vienna Austria
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Proton pump (H+/K+-ATPase) expression in human larynx. Auris Nasus Larynx 2015; 42:458-62. [DOI: 10.1016/j.anl.2015.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 12/23/2022]
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Papagerakis S, Bellile E, Peterson LA, Pliakas M, Balaskas K, Selman S, Hanauer D, Taylor JMG, Duffy S, Wolf G. Proton pump inhibitors and histamine 2 blockers are associated with improved overall survival in patients with head and neck squamous carcinoma. Cancer Prev Res (Phila) 2015; 7:1258-69. [PMID: 25468899 DOI: 10.1158/1940-6207.capr-14-0002] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It has been postulated that gastroesophageal reflux plays a role in the etiology of head and neck squamous cell carcinomas (HNSCC) and contributes to complications after surgery or during radiotherapy. Antacid medications are commonly used in patients with HNSCC for the management of acid reflux; however, their relationship with outcomes has not been well studied. Associations between histamine receptor-2 antagonists (H2RA) and proton pump inhibitors (PPI) use and treatment outcomes were determined in 596 patients with previously untreated HNSCC enrolled in our SPORE epidemiology program from 2003 to 2008 (median follow-up 55 months). Comprehensive clinical information was entered prospectively in our database. Risk strata were created on the basis of possible confounding prognostic variables (age, demographics, socioeconomics, tumor stage, primary site, smoking status, HPV16 status, and treatment modality); correlations within risk strata were analyzed in a multivariable model. Patients taking antacid medications had significantly better overall survival (OS; PPI alone: P < 0.001; H2RA alone, P = 0.0479; both PPI + H2RA, P = 0.0133). Using multivariable Cox models and adjusting for significant prognostic covariates, both PPIs and H2RAs used were significant prognostic factors for OS, but only H2RAs use for recurrence-free survival in HPV16-positive oropharyngeal patients. We found significant associations between the use of H2RAs and PPIs, alone or in combination, and various clinical characteristics. The findings in this large cohort study indicate that routine use of antacid medications may have significant therapeutic benefit in patients with HNSCC. The reasons for this association remain an active area of investigation and could lead to identification of new treatment and prevention approaches with agents that have minimal toxicities.
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Affiliation(s)
- Silvana Papagerakis
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Medical School, Ann Arbor, Michigan. Department of Periodontics-Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan.
| | - Emily Bellile
- Center for Cancer Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Lisa A Peterson
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Medical School, Ann Arbor, Michigan
| | - Maria Pliakas
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Medical School, Ann Arbor, Michigan
| | - Katherine Balaskas
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Medical School, Ann Arbor, Michigan
| | - Sara Selman
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Medical School, Ann Arbor, Michigan
| | - David Hanauer
- Clinical Informatics, Comprehensive Cancer Center Bioinformatics Core, University of Michigan, Ann Arbor, Michigan. Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jeremy M G Taylor
- Center for Cancer Biostatistics, University of Michigan, Ann Arbor, Michigan. Department of Biostatistics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sonia Duffy
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Medical School, Ann Arbor, Michigan. School of Nursing, University of Michigan, Ann Arbor, Michigan. Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan. VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, Michigan
| | - Gregory Wolf
- Department of Otolaryngology-Head and Neck Surgery University of Michigan Medical School, Ann Arbor, Michigan
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Kuo CL, Chen YT, Shiao AS, Lien CF, Wang SJ. Acid reflux and head and neck cancer risk: A nationwide registry over 13 years. Auris Nasus Larynx 2015; 42:401-5. [PMID: 25998850 DOI: 10.1016/j.anl.2015.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 03/12/2015] [Accepted: 03/20/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Gastro-esophageal reflux disease (GERD) is a highly prevalent disorder; however, important questions remain regarding the link between GERD and extra-esophageal cancers. This nationwide cohort study investigated the risk of developing head and neck cancers (HNCs) among patients with GERD. METHODS Newly diagnosed GERD patients aged ≥20 years without antecedent cancer were included. Case data were obtained from the National Health Insurance Research Database covering period from 1998 to 2010. We compared the standardized incidence ratios (SIRs) of cancer among GERD patients with those of the general population. RESULTS A total of 98 cancers were identified among the 39,845 GERD patients in the study, representing 128,361 person-years. The SIR for all cases of cancer was 1.59 (95% CI 1.29-1.93). GERD patients exhibited significantly higher SIRs for oropharyngeal (SIR 3.58, 95% CI 1.85-6.25) and hypopharyngeal (SIR 3.96, 95% CI 2.35-6.26) cancers. Male patients had a significantly higher risk of HNCs (SIR 1.70, 95% CI 1.36-2.10), particularly oropharyngeal (SIR 4.01, 95% CI 2.00-7.17) and hypopharyngeal (SIR 3.91, 95% CI 2.28-6.26) cancers. Following adjustment for age and co-morbidities, the hazard ratio was 9.06 (95% CI 4.70-17.44) for males compared to females. CONCLUSION There may be a potential association between GERD and risk of HNCs, which however merits further studies to confirm the causal relationship. Our observations indicate a need for careful extra-esophageal examination of patients with acid reflux. Our findings also underline the importance of raising awareness among clinicians regarding the possibility of concurrent HNCs in GERD patients with refractory laryngo-pharyngeal symptoms.
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Affiliation(s)
- Chin-Lung Kuo
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Otolaryngology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, ROC; Department of Otolaryngology-Head and Neck Surgery, National Defense Medical Center, Taipei, Taiwan, ROC.
| | - Yung-Tai Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan, ROC
| | - An-Suey Shiao
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Otolaryngology-Head and Neck Surgery, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chiang-Feng Lien
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Otolaryngology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, ROC.
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Higher levels of total pepsin and bile acids in the saliva as a possible risk factor for early laryngeal cancer. Radiol Oncol 2015; 49:59-64. [PMID: 25810702 PMCID: PMC4362607 DOI: 10.2478/raon-2014-0020] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 03/21/2014] [Indexed: 12/25/2022] Open
Abstract
Background Gastroesophageal reflux is suspected to be an etiological factor in laryngeal and pharyngeal cancer. The aim of this study was to establish, using a non-invasive method, whether laryngopharyngeal reflux (LPR) appears more often in patients with early laryngeal cancer than in a control group. Patients and methods We compared the pH, the level of bile acids, the total pepsin and the pepsin enzymatic activity in saliva in a group of 30 patients with T1 laryngeal carcinoma and a group of 34 healthy volunteers. Results The groups differed significantly in terms of levels of total pepsin and bile acids in the saliva sample. Higher levels of total pepsin and bile acids were detected in the group of cancer patients. No significant impact of other known factors influencing laryngeal mucosa (e.g. smoking, alcohol consumption, and the presence of irritating substances in the workplace) on the results of saliva analysis was found. Conclusions A higher level of typical components of LPR in the saliva of patients with early laryngeal cancer than in the controls suggests the possibility that LPR, especially biliary reflux, has a role in the development of laryngeal carcinoma.
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The development and treatment of periprosthetic leakage after prosthetic voice restoration. A literature review and personal experience part I: the development of periprosthetic leakage. Eur Arch Otorhinolaryngol 2014; 272:641-59. [PMID: 25404116 DOI: 10.1007/s00405-014-3394-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/07/2014] [Indexed: 01/04/2023]
Abstract
In the past 30 years, the use of a voice prosthesis has become the treatment of choice for the restoration of speech following laryngectomy. Not only is the placement of a voice prosthesis a simple surgical procedure, but it is also associated with a low rate of complications and an excellent success rate. Approximately, 20-30 % of all patients with voice prostheses, however, develop periprosthetic leakage with aspiration over time. Periprosthetic leakage is usually caused by an enlargement of the tracheo-oesophageal fistula and substantially affects the quality of life of the patients concerned. In a retrospective analysis of our patients, the incidence of periprosthetic leakage was 35.7 % in a total of 232 patients who underwent laryngectomy during a period of 20 years. Substantial enlargement of the tracheo-oesophageal fistula which required multiple treatments occurred in 12.5 % of the patients. In this review, the various causes of fistula enlargement are discussed on the basis of the literature and the experience that we have accumulated during the past 20 years in the management of patients with voice prostheses.
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Kelly EA, Samuels TL, Johnston N. Chronic pepsin exposure promotes anchorage-independent growth and migration of a hypopharyngeal squamous cell line. Otolaryngol Head Neck Surg 2014; 150:618-24. [PMID: 24376122 PMCID: PMC4423599 DOI: 10.1177/0194599813517862] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/03/2013] [Indexed: 12/31/2022]
Abstract
OUTCOME OBJECTIVES (1) Investigate the role of reflux, specifically pepsin, in laryngopharyngeal carcinogenesis. (2) Evaluate effects of chronic pepsin exposure on cell migration, apoptosis, and colony-forming ability in hypopharyngeal cells. STUDY DESIGN Translation research. SETTING Academic research laboratory. METHODS Human hypopharyngeal squamous carcinoma FaDu cells were chronically exposed to nonacidic pepsin (exposed for 24 hours, 4 times over 2 weeks at the following concentrations: 0.01 mg/mL, 0.1 mg/mL, or 1 mg/mL). Precise wounds were created in confluent cell plates, and rates of cell migration into wounds were quantified. Separately, cell viability of chronic pepsin-exposed FaDu cells acutely treated with paclitaxel was measured. Finally, a clonogenic assay was performed on these cells to measure effects of chronic pepsin exposure on colony-forming ability. RESULTS An increased rate of relative wound density was observed in chronic pepsin-treated (0.01 mg/mL, 0.1 mg/mL) cells compared with control (P < .001), suggesting greater rates of cell migration. Pepsin-treated (0.1 mg/mL) cells demonstrated on average greater cell viability compared with control after exposure to paclitaxel, suggesting possible apoptotic resistance; however, this was not statistically significant. Chronic pepsin exposure (0.1 mg/mL, 1 mg/mL) was associated with a dose-dependent increase in colony-forming ability relative to control (P < .001). CONCLUSION Hypopharyngeal squamous cell line chronically exposed to pepsin demonstrated increased cell migration and colony-forming ability relative to control cells. These experiments indicate that chronic pepsin exposure acts as a promoter of tumorigenesis and metastasis of airway epithelium, suggesting a role for pepsin in laryngopharyngeal carcinogenesis attributed to gastric reflux.
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Affiliation(s)
- Elizabeth A Kelly
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Stephenson KA, Fagan JJ. Effect of perioperative proton pump inhibitors on the incidence of pharyngocutaneous fistula after total laryngectomy: A prospective randomized controlled trial. Head Neck 2014; 37:255-9. [DOI: 10.1002/hed.23591] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 12/30/2022] Open
Affiliation(s)
- Kate A. Stephenson
- Division of Otorhinolaryngology; University of Cape Town, Groote Schuur Hospital; Cape Town South Africa
| | - Johannes J. Fagan
- Division of Otorhinolaryngology; University of Cape Town, Groote Schuur Hospital; Cape Town South Africa
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Chappity P, Kumar R, Deka RC, Chokkalingam V, Saraya A, Sikka K. Proton Pump Inhibitors Versus Solitary Lifestyle Modification in Management of Laryngopharyngeal Reflux and Evaluating Who is at Risk: Scenario in a Developing Country. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2014; 7:1-5. [PMID: 24653653 PMCID: PMC3948736 DOI: 10.4137/cment.s13799] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/19/2014] [Accepted: 01/20/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laryngopharyngeal reflux disease can present with a varied symptomatology because of the involvement of multiple sub-sites of the upper aero-digestive tract. It is a very common disease to be encountered in routine practice by both medical and ENT personnel. Its association with multiple pathologies including malignancy warrants an early diagnosis and management. The lack of cost effective and non-invasive tests constitutes a major hurdle in its early management. OBJECTIVES 1. To define the “at risk” population, prone to developing laryngopharyngeal reflux. 2. To formulate major and minor risk factors for the clinical diagnosis of patients with laryngopharyngeal reflux. 3. To evaluate the efficacy of lifestyle management alone as a treatment option. 4. To formulate a treatment protocol for the management of patients and to prevent recurrence. STUDY DESIGN We performed a prospective analysis of 234 patients diagnosed with laryngopharyngeal reflux. Patients were randomized into study and control groups based on the treatment protocol, using a computer generated randomization table and were single blinded to the type of therapy received. A complete analysis of the possible risk factors, symptoms, and signs was performed with statistical analysis. RESULTS AND CONCLUSION The data has helped us define the “at risk” population and formulate the criteria to diagnose cases of laryngopharyngeal reflux, clinically. The results emphasize the non-requirement of invasive or costly investigations for all patients and indicate the probable protocol to be followed prior to considering further investigation. The role of long term proton pump inhibitor treatment along with lifestyle modification in the initial phase of treatment, as mentioned in the literature, was re-confirmed by our study. However, in addition to the initial treatment, the study establishes the need for continuing lifestyle modification further for at least six months after the cessation of proton pump inhibitor therapy to prevent early recurrence of symptoms.
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Affiliation(s)
- Preetam Chappity
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Rakesh Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh C Deka
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anoop Saraya
- Department of Gastroenterology, AIIMS, New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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Johnston N, Dettmar PW, Strugala V, Allen JE, Chan WW. Laryngopharyngeal reflux and GERD. Ann N Y Acad Sci 2013; 1300:71-79. [PMID: 24117635 DOI: 10.1111/nyas.12237] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In patients with laryngopharygeal reflux (LPR), gastric contents exhibit retrograde flow into the upper aero-digestive tract, causing extraesophageal symptoms including chronic cough, hoarseness, indigestion, difficulty swallowing, globus pharyngis, and asthma. The following on laryngopharyngeal reflux includes commentaries on the use of patient-completed questionaires and anti-human pepsin antibodies and other non-invasive tests in diagnosis; the role of pepsin and acid in the etiologies of laryngeal cancers; and the application of proton pump inhibitor (PPI) therapy for the treatment of LPR.
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Affiliation(s)
- Nikki Johnston
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter W Dettmar
- Technostics Ltd, Castle Hill Hospital, Kingston-Upon-Hull, United Kingdom
| | - Vicki Strugala
- Technostics Ltd, Castle Hill Hospital, Kingston-Upon-Hull, United Kingdom
| | - Jacqui E Allen
- Department of Otolaryngology, North Shore Hospital, Auckland, New Zealand
| | - Walter W Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Cambridge, Massachusetts
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[Epidemiology of laryngeal and hypopharyngeal cancer in the period 1988-2012 in the material of the Otolaryngology Clinic of the Bialystok Medical University]. Otolaryngol Pol 2013; 67:265-73. [PMID: 24238109 DOI: 10.1016/j.otpol.2013.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 04/08/2013] [Accepted: 05/09/2013] [Indexed: 11/21/2022]
Abstract
UNLABELLED Malignant tumour is the second cause of death in Poland, behind cardiovascular disease. 26% of men and 23% of women die of it. Head and neck tumours are the fifth most frequent group of malignant tumours. These are mostly squamous cell carcinomas. The carcinogenic factors of tobacco smoke play an indisputable role in the pathogenesis of these tumours. AIM OF WORK Analysis comprising: number of patients, sex and age, site and stage of the primary tumour (T), clinical assessment of neck lymph nodes (N). The results underwent statistical analysis. MATERIALS AND METHODS The study involved 1313 patients who underwent surgery in the period 1988-2012 in the Otolaryngology Clinic in Bialystok (1199 men and 114 women, aged 32-86 years). RESULTS In the study group the proportion of men was 91.3% and women 8.7%. Histopathological verification confirmed squamous cell carcinomas in 99%. The primary tumour was most often located in the supraglottic area of the larynx (48.0%) and its clinical stage was T3 (33.5%). T1 tumours were statistically significantly more frequently found in the glottis and T4 tumours - in the hypopharynx and in the transglottic area. Swollen lymph nodes in the neck were found in 52.4% of the patients, most often N2 (37.4%). The highest percentage of patients with lymph node reaction was found in the youngest group (76.6%) and the lowest - in the eldest group (30.0%). Swollen lymph nodes were statistically relevantly more frequent in patients with supraglottic or hypopharynx tumour.
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Sandner A, Illert J, Koitzsch S, Unverzagt S, Schön I. Reflux induces DNA strand breaks and expression changes of MMP1+9+14 in a human miniorgan culture model. Exp Cell Res 2013; 319:2905-15. [PMID: 24075964 DOI: 10.1016/j.yexcr.2013.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 09/04/2013] [Accepted: 09/06/2013] [Indexed: 12/16/2022]
Abstract
Gastroesophageal reflux disease has been implicated in the pathogenesis of adenocarcinoma of the oesophagus. The same applies to laryngopharyngeal reflux (LPR) and squamous cell cancer of the head and neck, but so far, this link has not been proven. The impact of low pH and bile acids has not been studied extensively in cells other than oesophageal cancer cell lines and tissue. The aims of this study were to investigate the pathogenic potential of reflux and its single components on the mucosa of the upper respiratory tract. We measured DNA stability in human miniorgan cultures (MOCs) and primary epithelial cell cultures (EpCs) in response to reflux by the alkaline comet assay. As matrix metalloproteinases (MMPs) are involved in extracellular matrix remodelling processes and may contribute to cancer progression, we studied the expression of MMP1, -9, and -14 in MOCs, EpC, UM-SCC-22B, and FADUDD. DNA strand breaks (DNA-SBs) increased significantly at low pH and after incubation with human or artificial gastric juice. Single incubation with glycochenodeoxycholic acid also showed a significant increase in DNA-SBs. In epithelial cell cultures, human gastric juice increased the number of DNA-SBs at pH 4.5 and 5.5. Artificial gastric juice significantly up regulated the gene expression of MMP9. Western blot analysis confirmed the results of gene expression analysis, but the up regulation of MMP1, -9, and -14 was donor-specific. Reflux has the ability to promote genomic instability and may contribute to micro environmental changes suitable for the initiation of malignancy. Further functional gene analysis may elucidate the role of laryngopharyngeal reflux in the development of head neck squamous cell carcinoma (HNSCC).
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Affiliation(s)
- Annett Sandner
- Department of Otolaryngology, Head and Neck Surgery, Martin-Luther-University Halle-Wittenberg, D-06120 Halle, Germany.
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Coca-Pelaz A, Rodrigo JP, Takes RP, Silver CE, Paccagnella D, Rinaldo A, Hinni ML, Ferlito A. Relationship between reflux and laryngeal cancer. Head Neck 2013; 35:1814-8. [PMID: 23794281 DOI: 10.1002/hed.23208] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2012] [Indexed: 12/18/2022] Open
Abstract
Gastroesophageal reflux disease (GERD), or its variation known as laryngopharyngeal reflux (LPR), has been recognized as a potential cause of several laryngeal disorders. Patients with laryngeal cancer have lifestyle risk factors, especially tobacco and alcohol consumption, that play an etiological role in the development of their cancer but also places them at risk for reflux. The question then arises whether there is merely an association or a causal relationship between laryngeal cancer and reflux. However, despite a number of studies, a causal relationship with laryngeal cancer is uncertain. In this article, we address the current literature in a critical manner to evaluate the relationship between reflux and laryngeal cancer. From the review of the literature, we conclude that there is insufficient evidence to support a causal role of reflux in laryngeal cancer, mainly because of the confounding effect of tobacco and alcohol consumption and the inaccuracies in the diagnosis of reflux.
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Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
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Wang CP, Tseng PH, Chen TC, Lou PJ, Yang TL, Hu YL, Ko JY, Hsiao TY, Lee YC. Transnasal Esophagogastroduodenoscopy for Evaluation of Upper Gastrointestinal Non-Neoplastic Disorders in Patients With Fresh Hypopharyngeal Cancer. Laryngoscope 2013; 123:975-979. [DOI: 10.1002/lary.23726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Johnston N, Yan JC, Hoekzema CR, Samuels TL, Stoner GD, Blumin JH, Bock JM. Pepsin promotes proliferation of laryngeal and pharyngeal epithelial cells. Laryngoscope 2012; 122:1317-25. [PMID: 22570308 DOI: 10.1002/lary.23307] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 01/03/2012] [Accepted: 02/24/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE/HYPOTHESIS Laryngopharyngeal reflux (LPR) is thought to be a significant risk factor for laryngeal squamous cell carcinoma (SCC), but causality has never been proven. It is accepted that chronic reflux into the esophagus can induce metaplastic changes in esophageal mucosa with subsequent increased risk of esophageal adenocarcinoma, but no similar associations have been established for LPR and laryngopharyngeal SCC. The objective of this study was to test the hypothesis that reflux of pepsin into the laryngopharynx can promote carcinogenesis. STUDY DESIGN Translational research study. METHODS Normal human laryngeal primary epithelial cell cultures and hypopharyngeal FaDu SCC cells were exposed to human pepsin and analyzed by Human Cancer PathwayFinder and miRNA Superarrays, flow cytometry, and Western blot to determine the effect of pepsin on carcinogenesis. Laryngeal biopsy specimens taken from cancer patients and normal control subjects were analyzed for the presence of pepsin by Western blot. RESULTS Microarray analysis demonstrated that pepsin significantly altered the expression of 27 genes implicated in carcinogenesis and also affected the expression of 22 microRNAs known to be altered in human head and neck cancers. Pepsin increased proliferation in both FaDu SCC cells and cultured normal laryngeal epithelial primary cells by increasing S phase distribution on flow cytometry analysis in a time- and dose-dependent manner. Furthermore, pepsin was detected in 60% (3/5) human laryngeal cancer biopsies, absent in all (0/5) normal control specimens. CONCLUSIONS These data support a role for refluxed pepsin in the promotion of epithelial proliferation and carcinogenesis of the larynx and pharynx.
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Affiliation(s)
- Nikki Johnston
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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Zen Junior JH, Negro AD, Colli Neto JA, Araujo MR, Altemani AM, Andreollo NA. Experimental model of smoking and simulation of reflux with acid and pepsin in rats. Acta Cir Bras 2012; 27:18-22. [DOI: 10.1590/s0102-86502012000100004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 11/21/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To develop experimental models to evaluate the effects of hydrochloric acid associated with the pepsin instilled in the mucosa of the upper esophagus and the esophagogastric junction of young male rats Wistar, simulating injury caused by gastroesophageal reflux on the mucosa of aero-digestive tract in humans as well as the action of the risk exposure of mucosa to cigarette smoke. METHODS: Fifty young male Wistar rats divided in 5 groups with 10 animals each one, respectively simulating pharyngo-laryngeal reflux and gastroesophageal reflux, pharyngo-laryngeal reflux and smoking, smoking only, gastroesophageal reflux and control group. RESULTS: The histopathologic studies no recorded neoplasias, only mild changes and no significant alterations. The hemo-oximetry (carboxyhemoglobin and methemoglobim) and CO2 concentration confirm that the animals were submitted to high intensity of exposure to carcinogens in tobacco and its derivatives. CONCLUSION: The experimental models were highly efficient, practical, easy to use and economical and can be employed in other similar studies to determine the harmful effects by smoking and reflux.
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Kwon YS, Oelschlager BK, Merati AL. Evaluation and Treatment of Laryngopharyngeal Reflux Symptoms. Thorac Surg Clin 2011; 21:477-87. [DOI: 10.1016/j.thorsurg.2011.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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The role of laryngopharyngeal reflux as a risk factor in laryngeal cancer: a preliminary report. Clin Exp Otorhinolaryngol 2011; 4:101-4. [PMID: 21716948 PMCID: PMC3109325 DOI: 10.3342/ceo.2011.4.2.101] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Accepted: 04/24/2011] [Indexed: 11/26/2022] Open
Abstract
Objectives To evaluate the significance of laryngopharyngeal reflux (LPR) as a risk factor in laryngeal cancer. Methods We performed a case-control study with 29 consecutive laryngeal cancer patients who had undergone 24-hour ambulatory double pH monitoring from 2003 to 2006. The control group included 300 patients who had undergone 24-hour ambulatory double pH monitoring due to LPR-related symptoms. We analyzed the prevalence of LPR and numerous parameters from the 24-hour ambulatory double pH monitoring in the laryngeal cancer patient and control groups. Pathologic LPR is defined when more than three episodes of LPR occur in 24 hours. Results The prevalence of pathologic LPR was significantly higher in the laryngeal cancer group than the control group (P=0.049). The reflux number of the upper probe was significantly higher in the laryngeal cancer group (P<0.001). However the effects of pathologic LPR on laryngeal cancer risk were diluted after adjusting for smoking and alcohol consumption in the multivariable logistic regression. Conclusion The pathologic LPR might be a possible risk factor in the development of laryngeal cancer. A further study should be necessary to verify the exact role of LPR in laryngeal cancer.
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Lorenz KJ, Grieser L, Ehrhart T, Maier H. [Laryngectomised patients with voice prostheses: influence of supra-esophageal reflux on voice quality and quality of life]. HNO 2010; 59:179-87. [PMID: 21181392 DOI: 10.1007/s00106-010-2222-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We conducted a prospective study to assess the influence of supra-esophageal reflux on voice quality and quality of life in patients who had undergone laryngectomy and prosthetic voice rehabilitation. PATIENTS AND METHODS We investigated 60 laryngectomised patients using 24-h dual-probe pH monitoring before and 6 months after oral anti-reflux treatment with proton pump inhibitors (PPIs). Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30. Voice quality was quantified using the voice handicap index (VHI10). Quality of life and voice quality parameters were then correlated with the severity of reflux disease. RESULTS Patients with physiological reflux area index (RAI) scores had a mean VHI10 score of 46.4 (±11.4). VHI scores were found to increase to up to 64.1 (±9.6) with reflux severity (p=0.025). Total quality of life scores ranged from 115.8 (±24.7) in patients with physiological RAI scores to 131.0 (±33.1) in patients with highly pathological RAI scores (p=0.007). After 6 months of treatment with PPIs, VHI scores improved to a total score of 57.5 (±20.6, p=0.003). Quality of life scores improved to 123.3 (±29.0, p=0.045). CONCLUSION Supra-esophageal reflux influences voice quality and quality of life in laryngectomised patients with voice prostheses. This can be explained, for example, by an increased incidence of periprosthetic leakage, the presence of edema in the pharyngo-esophageal segment (where speech is produced), and general reflux symptoms. Rigorous treatment with anti-reflux medications leads to an improvement in reflux parameters that can be assessed objectively (RAI) and in correlated quality of life and voice quality parameters. For this reason, we recommend rigorous oral treatment with PPIs in laryngectomised patients with a confirmed diagnosis of supra-esophageal reflux.
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Affiliation(s)
- K J Lorenz
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf-Hals-Chirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
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Bock JM, Brawley MK, Johnston N, Samuels T, Massey BL, Campbell BH, Toohill RJ, Blumin JH. Analysis of Pepsin in Tracheoesophageal Puncture Sites. Ann Otol Rhinol Laryngol 2010; 119:799-805. [DOI: 10.1177/000348941011901203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objectives: Tracheoesophageal puncture (TEP) and prosthesis insertion is a well-established method of voice rehabilitation after laryngectomy. Maintenance of the prosthesis and tract can be challenging, and reflux to the TEP site has been proposed as a cause. The sites of TEP were evaluated for the presence of pepsin in tissue biopsy specimens and tract secretions to explore this association. Methods: Patients with TEP were interviewed for a history of symptoms related to reflux, medication use history, TEP voice quality, and incidence of TEP complications. Tissue biopsy specimens and tract secretions were obtained from TEP sites and analyzed for the presence of pepsin via sodium dodecyl sulfate–polyacrylamide gel electrophoresis Western blot analysis. Results: Twelve of 17 patients (47%) had some history of preoperative or postoperative symptoms of gastroesophageal reflux disease or laryngopharyngeal reflux. Pepsin was present within the TEP site in a total of 10 of 17 patients (58%; 7 of 17 tissue biopsy specimens and 6 of 7 secretion samples). There were no statistically significant associations between the presence of pepsin and sex, reflux history, use of acid suppressive medicine, or time since laryngectomy. Conclusions: Reflux with subsequent pepsin deposition into the TEP tract occurs in a majority of laryngectomy patients. Further studies on the effect of reflux on the health and function of the TEP tract are warranted.
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Heterotopic gastric mucosal patch of the esophagus is associated with higher prevalence of laryngopharyngeal reflux symptoms. Eur Arch Otorhinolaryngol 2010; 267:1793-9. [PMID: 20437050 DOI: 10.1007/s00405-010-1259-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 04/15/2010] [Indexed: 12/13/2022]
Abstract
Laryngopharyngeal reflux (LPR) is common in clinical practice. Heterotopic gastric mucosal patch of the proximal esophagus (HGMP) is reported to cause LPR symptoms. This study assessed the prevalence of LPR symptoms and correlation with the size of HGMP. Four hundred and sixty-two patients undergoing endoscopy were carefully questioned regarding LPR symptoms experienced in the previous 12 weeks. The size of the HGMP was assessed and documented during endoscopy. Clinicopathological classifications were assigned (types I-V) accordingly. HGMP [median one patch (range 1-3), median size 15 mm [3-35] was detected in 26 (19 HGM type I and 7 HGM type II] patients giving a prevalence of 5.6%. Among the indications, there were significantly more LPR symptoms as referral indications among patients with HGMP. There were no significant differences in the endoscopic findings. On specific enquiries, significantly more HGMP patients had experienced any LPR symptoms (73.1 vs. 25.9%, p < 0.001) specifically chronic cough (p = 0.002), throat discomfort/hoarseness (p < 0.001), globus sensation (p = 0.004), regurgitation (p < 0.001). HGMP patients also had more heartburn (p = 0.001). Larger HGMP (≥ 15 mm) was only associated with more chronic cough (p = 0.022). In conclusion, patients with HGMP have significantly more LPR symptoms. However, most were mild and detected through specific enquiries. Interestingly, the size of HGMP did not significantly affect the prevalence of LPR symptoms.
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Chung JH, Tae K, Lee YS, Jeong JH, Cho SH, Kim KR, Park CW, Han DS. The Significance of Laryngopharyngeal Reflux in Benign Vocal Mucosal Lesions. Otolaryngol Head Neck Surg 2009; 141:369-73. [DOI: 10.1016/j.otohns.2009.05.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 05/18/2009] [Accepted: 05/29/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE: To determine the significance of laryngopharyngeal reflux (LPR) in benign vocal mucosal lesions. STUDY DESIGN AND SETTING: A case-control study at the tertiary referral medical center. SUBJECTS AND METHODS: From April 2003 to December 2006, we studied 110 patients with benign vocal mucosal lesions who had undergone 24-hour ambulatory double pH monitoring. The control group included 200 patients who had undergone ambulatory 24-hour double-probe pH monitoring due to laryngopharyngeal reflux-related symptoms without specific findings of benign vocal mucosal lesions. Reflux symptom index and reflux finding score were measured. We compared the prevalence of pathologic laryngopharyngeal reflux and various parameters of the pH monitoring such as total reflux number, fraction time of pH below 4 in various positions, and DeMeester scores. RESULTS: The prevalence of pathologic laryngopharyngeal reflux was 65 percent in the control group, 66 percent in vocal nodule group, 75 percent in the vocal polyp group, and 90 percent in the Reinke's edema group. Patients with Reinke's edema had a significantly higher prevalence of pathologic laryngopharyngeal reflux than controls ( P = 0.016). LPR was associated with a significantly increased risk of Reinke's edema (odds ratio: 4.846, 95% confidence interval 1.093∼21.492). Total reflux number and DeMeester scores in the Reinke's edema group and fraction time of pH below 4 in the supine position in the vocal polyp group were significantly higher than those in the control group. CONCLUSION: Laryngopharyngeal reflux might play a role as an etiologic factor in Reinke's edema and vocal polyps.
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Affiliation(s)
- Jae Ho Chung
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyung Tae
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Yong Seop Lee
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jin Hyeok Jeong
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Seok Hyun Cho
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyung Rae Kim
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Chul Won Park
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Dong Soo Han
- Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
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Gale N, Michaels L, Luzar B, Poljak M, Zidar N, Fischinger J, Cardesa A. Current review on squamous intraepithelial lesions of the larynx. Histopathology 2009; 54:639-56. [DOI: 10.1111/j.1365-2559.2008.03111.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Del Negro A, Araújo MR, Tincani AJ, Meirelles L, Martins AS, Andreollo NA. Experimental carcinogenesis on the oropharyngeal mucosa of rats with hydrochloric acid, sodium nitrate and pepsin. Acta Cir Bras 2008; 23:337-42. [DOI: 10.1590/s0102-86502008000400007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 03/17/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To investigate the carcinogenic action of hydrochloric acid, pepsin and sodium nitrate on the oropharyngeal mucosa of rats, simulating the reflux of gastric contents. METHODS: Eighty-two Wistar rats were divided in seven groups and submitted to 2 or 3 weekly applications of hydrochloric acid, pepsin and sodium nitrate on the pharyngeal mucosa during six months. Study groups comprised 12 animals each. Rats in groups I and II were submitted to 2 (GI) or 3 (GII) weekly applications of 0.1N hydrochloric acid. Groups III and IV were submitted to 2 (GIII) or 3 (GIV) weekly applications of 0.1N hydrochloric acid solution with pepsin. Groups V and VI were submitted to 2 (GV) or 3 (GVI) weekly applications of 0.1N hydrochloric acid and treated with daily nitrate diluted in water. Group VII consisted of 10 animals submitted to 2 weekly applications of filtered water. RESULTS: No dysplasia, intra-epithelial neoplasia or invasive carcinomas were detected. Inflammatory changes were observed in varying degrees and mast cells were more common in Groups V and VI (p=0.006). CONCLUSION: The data of the current study could not corroborate the hypothesis that gastroesophageal and pharyngolaryngeal refluxes are carcinogenic factors to the laryngopharyngeal mucosa, and more studies are necessary in the future.
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McGlashan JA, Johnstone LM, Sykes J, Strugala V, Dettmar PW. The value of a liquid alginate suspension (Gaviscon Advance) in the management of laryngopharyngeal reflux. Eur Arch Otorhinolaryngol 2008; 266:243-51. [PMID: 18506466 DOI: 10.1007/s00405-008-0708-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 04/30/2008] [Indexed: 01/06/2023]
Abstract
Laryngopharyngeal reflux (LPR) refers to the backflow of stomach contents into the laryngopharynx. Increasing evidence has demonstrated that LPR is a contributing factor in some cases of hoarseness, vocal fatigue, voice breaks, cough and globus and chronic throat clearing. However, several randomised placebo-controlled trials of proton pump inhibitors in the treatment of LPR have been reported with the majority showing no significant benefit in patient symptom scores over placebo. The aim of this pilot clinical study was to investigate whether any improvement in LPR-related symptoms, using the Reflux Symptom Index (RSI), and clinical findings, using the Reflux Finding Score (RFS), could be achieved with treatment with a liquid alginate suspension compared to control (no treatment). Patients presenting with the symptoms of LPR to the Otorhinolaryngology Outpatient Department at the Queen's Medical Centre, Nottingham, UK were considered eligible if they had an RSI of greater than 10 and an RFS greater than 5 based on a fibreoptic examination of the larynx. A total of 49 patients were randomised into the open, parallel group study; 24 patients were randomised to receive 10 ml liquid alginate suspension (Gaviscon Advance) four times daily after meals and at bedtime, and 25 patients into the control group (no treatment). Patients were assessed pre-treatment and at 2, 4 and 6 months post treatment. Mean (SD) RSI and RFS pre-treatment scores were 23.9 (7.0) and 10.4 (3.6) for the treatment group and 24.6 (7.4) and 10.3 (3.3) for the control group, respectively. Significant differences between treatment and control were observed for RSI at the 2-month (11.2 (7.0) vs. 16.8 (6.4), P=0.005) and 6-month (11.2 (8.1) vs. 18.3 (9.4), P=0.008) assessments and for RFS at the 6-month (7.1 (2.8) vs. 9.5 (3.4), P=0.005) assessment. Significant improvement in symptom scores and clinical findings were achieved with liquid alginate suspension (Gaviscon Advance) compared to control and further evaluation for the management of patients presenting with LPR is warranted.
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Affiliation(s)
- Julian A McGlashan
- Department of Otorhinolaryngology Head and Neck Surgery, Queen's Medical Centre, Nottingham University Hospital, Nottingham NG7 2UH, UK
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Bercin S, Kutluhan A, Yurttas V, Yalcıner G, Bozdemir K, Sarı N. Evaluation of laryngopharyngeal reflux in patients with suspected laryngopharyngeal reflux, chronic otitis media and laryngeal disorders. Eur Arch Otorhinolaryngol 2008; 265:1539-43. [DOI: 10.1007/s00405-008-0710-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 04/30/2008] [Indexed: 11/24/2022]
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Mahieu HF. Review article: The laryngological manifestations of reflux disease; why the scepticism? Aliment Pharmacol Ther 2007; 26 Suppl 2:17-24. [PMID: 18081645 DOI: 10.1111/j.1365-2036.2007.03474.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite increasing clinical and experimental evidence of its existence, otolaryngological manifestations of reflux disease remain controversial, concerning diagnosis as well as treatment. AIM Proper understanding of laryngopharyngeal reflux disease (LPRD). METHOD Review of literature. RESULTS Scepticism concerning LPRD is based upon differences between gastro-oesophageal reflux disease and LPRD; lack of specificity and sensitivity of diagnostic tests to confirm LPRD; non-specificity of laryngological symptoms, which are difficult to distinguish from other causes of upper respiratory tract inflammation; non-specificity of laryngological signs in laryngoscopy, with high intra- and inter-observer variability in evaluation; diagnosis of LPRD is essentially only based on a combination of diagnostic signs and symptoms, which cannot be attributed to other pathology; slow, or sometimes lack of, response of LPRD symptoms to proton pump inhibitor (PPI) medication and lack of evidence concerning efficacy of PPIs in placebo-controlled trials. CONCLUSIONS LPRD remains a diagnosis by exclusion and resolution of symptoms following 4-month trial of 40 mg PPI twice daily is, for all practical purposes, considered proof of the initial diagnosis. However, non-response does not exclude LPRD as PPIs have no influence on noxious non-acid components of the refluxate.
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Affiliation(s)
- H F Mahieu
- Department of Otorhinolaryngology, Meander Medical Centre, Amersfoort, The Netherlands.
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Laparoscopic Nissen fundoplication effectively relieves symptoms in patients with laryngopharyngeal reflux. J Gastrointest Surg 2007; 11:1579-87; discussion 1587-8. [PMID: 17932726 DOI: 10.1007/s11605-007-0318-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 08/27/2007] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The utility of laparoscopic Nissen fundoplication in the treatment of laryngopharyngeal reflux symptoms remains controversial. We hypothesized that a carefully selected population with these symptoms would benefit from antireflux surgery. MATERIALS AND METHODS Sixty-one consecutive patients have undergone antireflux surgery for laryngopharyngeal reflux at a single institution. Preoperative evaluation including upper endoscopy, laryngoscopy, and 24-h ambulatory pharyngeal pH probe monitoring confirmed the diagnosis. Patients completed two validated symptom assessment instruments preoperatively and at multiple time points postoperatively. RESULTS Patients were followed for up to 3 years with a mean follow-up of 15.2 months. A significant improvement in reflux symptom index score (preoperative= 1.5+/-7.4 vs 3 years=12.4+/-10.9, p<0.01), laryngopharyngeal reflux health-related quality of life overall score (preoperative=55.0+/-26.0 vs 3 years=11.3+/-13.9, p<0.01), and symptom domain scores (voice, cough, throat clearing, and swallowing) occurred within 1 month of surgery and remained improved over the course of the study. CONCLUSION Laparoscopic Nissen fundoplication is effective in relieving the symptoms of laryngopharyngeal reflux in a carefully selected patient population. Benefits are seen within 1 month of surgery and persist for at least 3 years.
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Marín Garrido C, Fernández Liesa R, Vallès Varela H, Naya Gálvez MJ. Estudio del reflujo laringofaríngeo mediante pH-metría en el postoperatorio inmediato de los laringectomizados. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s0001-6519(07)74930-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gurski RR, da Rosa ARP, do Valle E, de Borba MA, Valiati AA. Extraesophageal manifestations of gastroesophageal reflux disease. J Bras Pneumol 2007; 32:150-60. [PMID: 17273585 DOI: 10.1590/s1806-37132006000200011] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 07/07/2005] [Indexed: 02/07/2023] Open
Abstract
Gastroesophageal reflux disease often presents as heartburn and acid reflux, the so-called "typical" symptoms. However, a subgroup of patients presents a collection of signs and symptoms that are not directly related to esophageal damage. These are known collectively as the extraesophageal manifestations of gastroesophageal reflux disease. Principal among such manifestations are bronchospasm, chronic cough and laryngitis, which are classified as atypical symptoms. These manifestations comprise a heterogeneous group. However, some generalizations can be made regarding all of the subgroups. First, although the correlation between gastroesophageal reflux disease and the extraesophageal manifestations has been well established, a cause-and-effect relationship has yet to be definitively elucidated. In addition, the main proposed pathogenic mechanisms of extraesophageal reflux are direct injury of the extraesophageal tissue (caused by contact with gastric acid) and the esophagobronchial reflex, which is mediated by the vagus nerve. Furthermore, gastroesophageal reflux disease might not be considered in the differential diagnosis of patients presenting only the atypical symptoms. In this article, we review the extraesophageal manifestations of gastroesophageal reflux disease, discussing its epidemiology, pathogenesis, diagnosis and treatment. We focus on the most extensively studied and well-established presentations.
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De Corso E, Baroni S, Agostino S, Cammarota G, Mascagna G, Mannocci A, Rigante M, Galli J. Bile acids and total bilirubin detection in saliva of patients submitted to gastric surgery and in particular to subtotal Billroth II resection. Ann Surg 2007; 245:880-5. [PMID: 17522513 PMCID: PMC1876966 DOI: 10.1097/01.sla.0000255574.22821.a1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of our study was to detect bile acids and total bilirubin in saliva of gastrectomized patients, to confirm objectively presence of biliary laryngopharyngeal reflux and its relationship with laryngeal mucosa damage. SUMMARY BACKGROUND DATA Recently, it has been hypothesized that biliary-reflux may reach the upper aerodigestive tract and enhance development of laryngeal malignancies; nevertheless, the presence of duodenogastric contents in this region has never been revealed. METHODS We carried out a prospective observational case-control study on 52 patients (cases) previously submitted to gastric surgery, mainly to subtotal Billroth II resection, and on 51 healthy volunteers (controls). Patients were submitted to clinical interview, esophagogastroduodenal endoscopy, endoscopic laryngeal evaluation, and saliva collection. In all saliva samples, bile acids, total bilirubin, and pepsinogen II were assayed. RESULTS In cases, group bile acids levels were recorded in 17 of 52 (32.6%) patients, while in 35 of 52 (67.4%) they were undetectable. All controls were negative to bile acids. In positive cases to bile acids, we found a significant (P < 0.05) correlation between bile acids, total bilirubin, and pepsinogen II values and a significant (P < 0.05) higher prevalence of symptoms and findings of laryngeal damage and of previous laryngeal neoplastic lesions. CONCLUSIONS We found detectable levels of bile acids and total bilirubin in saliva of patients submitted to previous gastric surgery, prospecting an intriguing diagnostic role of this dosage in the study of biliary laryngopharyngeal reflux. We finally revealed a high incidence of laryngeal disorders in patients with positive bile acids in saliva.
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Affiliation(s)
- Eugenio De Corso
- Institute of Otorhinolaryngology, Catholic University of Medicine and Surgery, Catholic University of the Sacred Heart, Policlinico A. Gemelli No. 1, 00168 Rome, Italy.
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