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Chi ZC. Reflux hypersensitivity. Shijie Huaren Xiaohua Zazhi 2018; 26:885-891. [DOI: 10.11569/wcjd.v26.i15.885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Reflux hypersensitivity (RH) is a condition characterized typically by heart burn, normal gastroscopy and esophageal biopsy, normal esophageal pH-impedance test, and a close correlation between heart burn and reflux events. Recently, Rome Ⅳ criteria suggests that reflux hypersensitivity is a new type of esophageal functional disease. It is very common in clinical practice and often coexists with functional heartburn. Diagnosis is based on heartburn symptoms, gastroscopy, esophageal biopsy, esophageal pH-impedance, and high resolution esophageal pressure. RH patients have normal acid exposure, and there is no dynamic disease in esophageal dynamic test. However, there are still some difficulties in the differential diagnosis of esophageal functional diseases. Symptom associated probability cannot reliably distinguish reflux hypersensitivity and functional heartburn. The pathogenesis of RH is not entirely clear. Recent studies have shown that esophageal sensitivity to acid and mucosal integrity can lead to RH. Because more than 90% of patients do not respond to proton pump inhibitors, esophageal neuromodulators, such as tricyclic antidepressants, are the main treatment, but the efficacy is uncertain. Surgery is a desirable method, but the indications should be strictly selected. In the future, it is important to strengthen the research of RH pathogenesis and seek new therapeutic targets.
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Affiliation(s)
- Zhao-Chun Chi
- Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao 266011, Shandong Province, China
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Silva RO, Bingana RD, Sales TMAL, Moreira RLR, Costa DVS, Sales KMO, Brito GAC, Santos AA, Souza MÂN, Soares PMG, Sifrim D, Souza MHLP. Role of TRPV1 receptor in inflammation and impairment of esophageal mucosal integrity in a murine model of nonerosive reflux disease. Neurogastroenterol Motil 2018; 30:e13340. [PMID: 29573069 DOI: 10.1111/nmo.13340] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 02/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Microscopic inflammation and impairment of the esophageal epithelial barrier are considered relevant for perception of symptoms in patients with nonerosive reflux disease (NERD). In these patients, the receptor transient receptor potential vanilloid 1 (TRPV1) is overexpressed in the esophageal mucosa, but its role is not yet fully understood. We evaluated the role of TRPV1 in esophageal inflammation and mucosal barrier impairment in a murine model of NERD. METHODS Nonerosive reflux disease was surgically induced in Swiss mice by pyloric substenosis and ligature of the gastric fundus, and the mice were killed 7 days post surgery. The experimental groups were: I, sham surgery (negative control); II, NERD untreated; III and IV, NERD + SB366791 or capsazepine (TRPV1 antagonists); and V, NERD + resiniferatoxin (for long-term desensitization of TRPV1). The esophagus was collected for western blotting and histopathology and for evaluation of wet weight, myeloperoxidase (MPO), keratinocyte-derived chemokine (KC), transepithelial electrical resistance (TEER), and basal permeability to fluorescein. KEY RESULTS Compared to sham, NERD mice had increased esophageal wet weight and MPO and KC levels. The mucosa had no ulcers but exhibited inflammation. NERD mice showed mucosal TRPV1 overexpression, a more pronounced decrease in TEER at pH 0.5 (containing pepsin and taurodeoxycholic acid), and increased basal permeability. Pharmacological modulation of TRPV1 prevented esophageal inflammation development, TEER changes by acidic exposure, and increase in esophageal permeability. CONCLUSIONS & INFERENCES The TRPV1 receptor has a critical role in esophageal inflammation and mucosal barrier impairment in NERD mice, suggesting that TRPV1 might be a pharmacological target in patients with NERD.
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Affiliation(s)
- R O Silva
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - R D Bingana
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - T M A L Sales
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - R L R Moreira
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - D V S Costa
- Department of Morphology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - K M O Sales
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - G A C Brito
- Department of Morphology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - A A Santos
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - M Â N Souza
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - P M G Soares
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Department of Morphology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - D Sifrim
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - M H L P Souza
- Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
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Moda I, Ricz HMA, Aguiar-Ricz LN, Dantas RO. SWALLOWING IN PATIENTS WITH LARYNGITIS. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55:50-54. [PMID: 29561977 DOI: 10.1590/s0004-2803.201800000-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dysphagia is described as a complaint in 32% of patients with laryngitis. OBJECTIVE The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. METHODS Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. RESULTS The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. CONCLUSION A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.
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Affiliation(s)
- Isabela Moda
- Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço e Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Hilton Marcos Alves Ricz
- Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço e Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Lilian Neto Aguiar-Ricz
- Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço e Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Roberto Oliveira Dantas
- Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço e Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Savarino E, Coletta MD. Oesophagus: Symptom perception in patients with NERD: do nerves matter? Nat Rev Gastroenterol Hepatol 2017; 14:634-636. [PMID: 28874836 DOI: 10.1038/nrgastro.2017.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | - Marco Della Coletta
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
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