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Li Y, Chen M. IL-17 expression and prognosis of laryngeal squamous cell carcinoma. EAR, NOSE & THROAT JOURNAL 2024:1455613241232500. [PMID: 38357743 DOI: 10.1177/01455613241232500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Objective: To investigate the roles of proinflammatory cytokine IL-17 in the prognosis of laryngeal squamous cell carcinoma (LSCC). Methods: In all, 67 LSCC patients were enrolled to evaluate the expression of IL-17, IL-23, CD8, CD31, and vascular endothelial growth factor by immunohistochemical staining. Cumulative survival time was determined by the Kaplan-Meier approach, and prognostic variables for overall survival (OS) were identified by Cox proportional-hazards models. Results: The expression of IL-17 and IL-23 was remarkably higher in LSCC tissue than in adjacent normal (AN) tissue (P < .001). The Kaplan-Meier analysis indicated that patients with cervical lymph node metastasis (CLNM), advanced tumor node metastasis (TNM) stage, poor-differentiated grade, high microvessel density (MVD) in LSCC tissues, and high IL-17 expression in AN tissues had poorer OS (all P < .05). Cox regression analysis revealed that CLNM (HR = 7.246; 95% CI: 2.598-20.208; P < .001), high MVD in tumor tissues (HR = 4.233; 95% CI: 1.482-12.092; P = .007), and low CD8 expression in AN tissues (HR = 3.996; 95% CI: 1.442-11.074; P = .008) were significantly associated with poorer OS in LSCC, while IL-17 expression in AN tissue was not. Conclusion: High IL-17 expression in AN tissues could indicate poor prognosis and may be a prognostic marker for LSCC. Low CD8 expression in AN tissues may represent poor frontline antitumor immunity and be associated with poor prognosis.
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Affiliation(s)
- Yun Li
- Department of Otolaryngology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ming Chen
- Department of Otolaryngology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Lesnick A, Samuels TL, Seabloom D, Wuertz B, Ojha A, Seelig D, Ondrey F, Wiedmann TS, Hogan C, Torii E, Ouyang H, Yan K, Garcia GJM, Bock JM, Johnston N. Inhaled fosamprenavir for laryngopharyngeal reflux: Toxicology and fluid dynamics modeling. Laryngoscope Investig Otolaryngol 2024; 9:e1219. [PMID: 38362183 PMCID: PMC10866582 DOI: 10.1002/lio2.1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/20/2023] [Accepted: 01/11/2024] [Indexed: 02/17/2024] Open
Abstract
Objectives Approximately 25% of Americans suffer from laryngopharyngeal reflux (LPR), a disease for which no effective medical therapy exists. Pepsin is a predominant source of damage during LPR and a key therapeutic target. Fosamprenavir (FOS) inhibits pepsin and prevents damage in an LPR mouse model. Inhaled FOS protects at a lower dose than oral; however, the safety of inhaled FOS is unknown and there are no inhalers for laryngopharyngeal delivery. A pre-Good Lab Practice (GLP) study of inhaled FOS was performed to assess safety and computational fluid dynamics (CFD) modeling used to predict the optimal particle size for a laryngopharyngeal dry powder inhaler (DPI). Methods Aerosolized FOS, amprenavir (APR), or air (control) were provided 5 days/week for 4 weeks (n = 6) in an LPR mouse model. Organs (nasal cavity, larynx, esophagus, trachea, lung, liver, heart, and kidney) were assessed by a pathologist and bronchoalveolar lavage cytokines and plasma cardiotoxicity markers were assessed by Luminex assay. CFD simulations were conducted in a model of a healthy 49-year-old female. Results No significant increase was observed in histologic lesions, cytokines, or cardiotoxicity markers in FOS or APR groups relative to the control. CFD predicted that laryngopharyngeal deposition was maximized with aerodynamic diameters of 8.1-11.5 μm for inhalation rates of 30-60 L/min. Conclusions A 4-week pre-GLP study supports the safety of inhaled FOS. A formal GLP assessment is underway to support a phase I clinical trial of an FOS DPI for LPR. Level of Evidence NA.
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Affiliation(s)
- Alexandra Lesnick
- Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Tina L. Samuels
- Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Donna Seabloom
- Otolaryngology Head and Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Beverly Wuertz
- Otolaryngology Head and Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Abhilash Ojha
- Mechanical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Davis Seelig
- Comparative Pathology Shared ResourceMasonic Cancer Center, University of MinnesotaMinneapolisMinnesotaUSA
| | - Frank Ondrey
- Otolaryngology Head and Neck SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | | - Chris Hogan
- Mechanical EngineeringUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Emma Torii
- Comparative Pathology Shared ResourceMasonic Cancer Center, University of MinnesotaMinneapolisMinnesotaUSA
| | - Hui Ouyang
- Mechanical EngineeringUniversity of Texas‐DallasDallasTexasUSA
| | - Ke Yan
- Pediatrics Quantitative Health SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Guilherme J. M. Garcia
- Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
- Biomedical EngineeringMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Jonathan M. Bock
- Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Nikki Johnston
- Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeWisconsinUSA
- Microbiology and ImmunologyMedical College of WisconsinMilwaukeeWisconsinUSA
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Liu L, Wang X, Zhang J, Liu Z, Zhang C, Pan Y, Li J. Relationship Between Laryngopharyngeal Reflux and Obstructive Sleep Apnea in Adult Males. J Voice 2023:S0892-1997(23)00294-1. [PMID: 37833112 DOI: 10.1016/j.jvoice.2023.09.018] [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: 08/10/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To investigate the relationship between laryngopharyngeal reflux (LPR) and obstructive sleep apnea (OSA). METHODS Patients diagnosed with OSA who were hospitalized in the Department of Otolaryngology-Head and Neck Surgery from November 2021 to April 2022 were selected, and male patients with non-OSA during the same period were selected as the control group. Patients who participated in the study completed the Reflux Symptom Index (RSI), the Reflux Finding Sign (RFS), and 24-hour multichannel intraluminal impedance-pH (MII-pH) monitoring. RSI, RFS, and outcomes of 24 hour-MII-pH monitoring were compared between the OSA group and the control group. RESULTS A total of 86 patients were enrolled, of whom 49 were OSA patients and 37 were non-OSA patients. The positive rate of LPR (97.96% vs 75.68%) and the median number of LPR episodes (9 vs 5) were significantly higher in OSA patients than in non-OSA patients (P < 0.01, P < 0.05, respectively). A logistic regression model including body mass index, alcohol consumption, and the presence of OSA showed that having OSA was a risk factor for the occurrence of LPR (P < 0.05, OR [odds ratio] = 9.995, 95% CI [confidence interval] 1.084-92.181). There were correlations between Apnea-Hypopnea Index and the number of non-acid LPR episodes and the number of alkaline LPR episodes (r = 0.243, P < 0.05, r = 0.274, P < 0.05, respectively). CONCLUSIONS Having OSA is a risk factor for LPR, and LPR episodes occur more frequently in patients with OSA compared to those without OSA. When OSA is comorbid with LPR, the occurrence of alkaline LPR, such as bile reflux, should be a concurrent concern.
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Affiliation(s)
- Lianlian Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China; Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaoyu Wang
- Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Jinhong Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Zhi Liu
- Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Chun Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Yufei Pan
- Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Jinrang Li
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China; Department of Otolaryngology-Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, China.
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Liu Y, Lai H, Zhang R, Xia L, Liu L. Causal relationship between gastro-esophageal reflux disease and risk of lung cancer: insights from multivariable Mendelian randomization and mediation analysis. Int J Epidemiol 2023; 52:1435-1447. [PMID: 37344162 DOI: 10.1093/ije/dyad090] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 06/13/2023] [Indexed: 06/23/2023] Open
Abstract
AIM A recent study has reported that anti-reflux surgery reduced the risk of lung cancer. However, the exact causal association between gastro-esophageal reflux disease (GORD) and lung cancer remains obscure. Therefore, we conducted a multivariable and network Mendelian randomization (MR) study to explore this potential association and mediation effect. METHODS Independent single nucleotide polymorphisms (SNPs) strongly associated with GORD were selected as instrumental variables (IVs) from the corresponding genome-wide association studies (GWAS). The summary statistics were obtained from the largest GORD GWAS meta-analysis of 367 441 (78 707 cases) European individuals, and the summary statistics of lung cancer and pathological subtypes came from International Lung Cancer Consortium (ILCCO) and FinnGen databases. Univariable and multivariable MR analyses were performed to investigate and verify the causal relationship between genetically predicted GORD and lung cancer. Network MR analysis was conducted to reveal the mediating role of GORD between smoking initiation and lung cancer. RESULTS The univariable MR analysis demonstrated that GORD was associated with an increased risk of total lung cancer in both ILCCO [inverse variance weighted (IVW): odds ratio (OR) = 1.37, 95% confidence interval (CI) 1.16-1.62, P = 1.70E-04] and FinnGen database (IVW: OR = 1.25, 95% confidence interval CI 1.03-1.52, P = 2.27E-02). The consistent results were observed after adjusting the potential confounders [smoking traits, body mass index (BMI) and type 2 diabetes] in multivariable MR analyses. In subtype analyses, GORD was associated with lung adenocarcinoma (IVW: OR = 1.27, 95% CI 1.02-1.59, P = 3.48E-02) and lung squamous cell carcinomas (IVW: OR = 1.50, 95% CI 1.22-1.86, P = 1.52E-04). Moreover, GORD mediated 32.43% (95% CI 14.18-49.82%) and 25.00% (95% CI 3.13-50.00%) of the smoking initiation effects on lung cancer risk in the ILCCO and FinnGen databases, respectively. CONCLUSION This study provides credible evidence that genetically predicted GORD was significantly associated with an increased risk of total lung cancer, lung adenocarcinoma and lung squamous cell carcinomas. Furthermore, our results suggest GORD is involved in the mechanism of smoking initiation-induced lung cancer.
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Affiliation(s)
- Yi Liu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Hongjin Lai
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Ren Zhang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Liang Xia
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Lunxu Liu
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China
- Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, China
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Tran CL, Han M, Kim B, Park EY, Kim YI, Oh J. Gastroesophageal reflux disease and risk of cancer: Findings from the Korean National Health Screening Cohort. Cancer Med 2023; 12:19163-19173. [PMID: 37676071 PMCID: PMC10557881 DOI: 10.1002/cam4.6500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023] Open
Abstract
AIM Little is known about the association of cancers other than esophageal adenocarcinoma with gastroesophageal reflux disease (GERD). This study aimed to examine the association between GERD and the risk of different types of cancer. METHODS A cohort study was conducted using data from the National Health Screening Cohort. We included 10,261 GERD patients and 30,783 non-GERD individuals who were matched in a 1:3 ratio by age and sex. All participants were followed-up until cancer diagnosis, death, or end of the study (December 31, 2015). Hazard ratios were calculated using the Cox proportional hazards model, adjusting for smoking and alcohol consumption, physical activity, body mass index, income, area, and Charlson Comorbidity Index. RESULTS The median follow-up time was 9.9 years. GERD was associated with an increased risk of esophageal (adjusted hazard ratios [aHR] = 3.20 [1.89-5.41]), laryngeal (aHR = 5.42 [2.68-10.96]), and thyroid cancers (aHR = 1.91 [1.55-2.34]) after controlling for all covariates. The results were consistent when examining GERD with esophagitis (K210) and without esophagitis (K219) separately. For thyroid cancer, the results were insignificant after controlling for having ever-received thyroid biopsy procedures. A dose-response relationship was found between GERD and esophageal cancer as well as laryngeal cancer, with patients with a longer duration of GERD treatment showing a stronger effect. In contrast, GERD was associated with a reduced risk of colorectal (aHR = 0.73 [0.59-0.90]), liver (aHR = 0.67 [0.51-0.89]), and pancreatic cancers (aHR = 0.43 [0.24-0.76]), which might have resulted from differences in healthcare utilization between GERD and non-GERD groups. CONCLUSION GERD was associated with an increased risk of esophageal and laryngeal cancers. Additionally, early detection and treatment of precancerous lesions among the GERD group could lead to a lower risk of colorectal, liver, and pancreatic cancers.
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Affiliation(s)
- Chi Lan Tran
- Department of Cancer Control and Population HealthGraduate School of Cancer Science and Policy, National Cancer CenterGoyang‐siGyeonggi‐doRepublic of Korea
| | - Minji Han
- Department of Cancer Control and Population HealthGraduate School of Cancer Science and Policy, National Cancer CenterGoyang‐siGyeonggi‐doRepublic of Korea
- Division of Cancer PreventionNational Cancer CenterGoyang‐siGyeonggi‐doRepublic of Korea
- Department of Health Science and Technology, Graduate School of Convergence Science and TechnologySeoul National UniversitySeoulRepublic of Korea
| | - Byungmi Kim
- Division of Cancer PreventionNational Cancer CenterGoyang‐siGyeonggi‐doRepublic of Korea
| | - Eun Young Park
- Department of Preventive MedicineKorea University College of MedicineSeoulRepublic of Korea
| | - Young Il Kim
- Center for Gastric CancerNational Cancer CenterGoyang‐siGyeonggi‐doRepublic of Korea
| | - Jin‐Kyoung Oh
- Department of Cancer Control and Population HealthGraduate School of Cancer Science and Policy, National Cancer CenterGoyang‐siGyeonggi‐doRepublic of Korea
- Division of Cancer PreventionNational Cancer CenterGoyang‐siGyeonggi‐doRepublic of Korea
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Samuels TL, Blaine‐Sauer S, Yan K, Johnston N. Amprenavir inhibits pepsin-mediated laryngeal epithelial disruption and E-cadherin cleavage in vitro. Laryngoscope Investig Otolaryngol 2023; 8:953-962. [PMID: 37621274 PMCID: PMC10446255 DOI: 10.1002/lio2.1102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/12/2023] [Indexed: 08/26/2023] Open
Abstract
Background Laryngopharyngeal reflux (LPR) causes chronic cough, throat clearing, hoarseness, and dysphagia and can promote laryngeal carcinogenesis. More than 20% of the US population suffers from LPR and there is no effective medical therapy. Pepsin is a predominant source of damage during LPR which disrupts laryngeal barrier function potentially via E-cadherin cleavage proteolysis and downstream matrix metalloproteinase (MMP) dysregulation. Fosamprenavir (FDA-approved HIV therapeutic and prodrug of amprenavir) is a pepsin-inhibiting LPR therapeutic candidate shown to rescue damage in an LPR mouse model. This study aimed to examine amprenavir protection against laryngeal monolayer disruption and related E-cadherin proteolysis and MMP dysregulation in vitro. Methods Laryngeal (TVC HPV) cells were exposed to buffered saline, pH 7.4 or pH 4 ± 1 mg/mL pepsin ± amprenavir (10-60 min). Analysis was performed by microscopy, Western blot, and real time polymerase chain reaction (qPCR). Results Amprenavir (1 μM) rescued pepsin acid-mediated cell dissociation (p < .05). Pepsin acid caused E-cadherin cleavage indicative of regulated intramembrane proteolysis (RIP) and increased MMP-1,3,7,9,14 24-h postexposure (p < .05). Acid alone did not cause cell dissociation or E-cadherin cleavage. Amprenavir (10 μM) protected against E-cadherin cleavage and MMP-1,9,14 induction (p < .05). Conclusions Amprenavir, at serum concentrations achievable provided the manufacturer's recommended dose of fosamprenavir for HIV, protects against pepsin-mediated cell dissociation, E-cadherin cleavage, and MMP dysregulation thought to contribute to barrier dysfunction and related symptoms during LPR. Fosamprenavir to amprenavir conversion by laryngeal epithelia, serum and saliva, and relative drug efficacies in an LPR mouse model are under investigation to inform development of inhaled formulations for LPR.
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Affiliation(s)
- Tina L. Samuels
- Department of Otolaryngology and Communication Sciences, Medical College of WisconsinMilwaukeeWisconsinUSA
| | - Simon Blaine‐Sauer
- Department of Otolaryngology and Communication Sciences, Medical College of WisconsinMilwaukeeWisconsinUSA
| | - Ke Yan
- Department of Pediatrics Quantitative Health Sciences, Medical College of WisconsinMilwaukeeWisconsinUSA
| | - Nikki Johnston
- Department of Otolaryngology and Communication Sciences, Medical College of WisconsinMilwaukeeWisconsinUSA
- Department of Microbiology and ImmunologyMedical College of WisconsinMilwaukeeWisconsinUSA
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Wu L, Wu QC. Experience of individualized nursing in patients with laryngeal squamous cell carcinoma combined with Helicobacter pylori infection after surgery. J Cancer Res Clin Oncol 2023; 149:6575-6582. [PMID: 36781505 DOI: 10.1007/s00432-023-04627-z] [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: 12/15/2022] [Accepted: 01/29/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To explore the effect of personalized nursing on the therapeutic effect on patients with laryngeal squamous cell carcinoma (LSCC) combined with Helicobacter pylori (HP) infection after surgery. METHODS This study enrolled 46 patients with LSCC as research subjects. The patients were divided into an experimental group and a control group using the random number table method. Routine nursing was provided in the control group, and individualized nursing intervention was conducted in the experimental group based on routine nursing. The incidence of adverse reactions (ARs) and the patients' nursing satisfaction were compared between the two groups. RESULTS Compared with the control group, the individualized nursing intervention reduced the incidence of ARs of esophageal reflux (P < 0.05) and improved nursing satisfaction (P < 0.05). CONCLUSION Individualized nursing intervention reduced the incidence of esophageal reflux ARs in patients with LSCC and HP infection after tracheotomy and improved both the therapeutic effect of the treatment and the satisfaction of the patients.
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Affiliation(s)
- Li Wu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Yangtze University, Shashi District, 8 Aviation Road, Jingzhou, 434000, Hubei, China
| | - Qing-Cui Wu
- Infectious Diseases Department, The First Affiliated Hospital of Yangtze University, Shashi District, 8 Aviation Road, Jingzhou, 434000, Hubei, China.
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Lian X, Lin Y, Peng X, Wang Y, He T, He Z, Gu W, Wang H, He F, Huang Y. Causal links between socioeconomic status, leisure sedentary behaviours and gastro-oesophageal reflux disease: a multivariable two-sample Mendelian randomisation study. J Epidemiol Community Health 2023; 77:460-467. [PMID: 37185224 DOI: 10.1136/jech-2023-220311] [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: 01/12/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION We implemented a two-sample multivariable Mendelian randomisation (MR) analyses to estimate the causal effect of socioeconomic status and leisure sedentary behaviours on gastro-oesophageal reflux disease (GERD). METHODS Independent single-nucleotide polymorphisms associated with socioeconomic status and leisure sedentary behaviours at the genome-wide significance level from the Medical Research Council Integrative Epidemiology Unit (MRC-IEU) UK Biobank were selected as instrumental variables. Summary-level data for GERD were obtained from a recent publicly available genome-wide association involving 78 707 GERD cases and 288 734 controls of European descent. Univariable and multivariable two-sample MR analyses, using inverse variance weighted method for primary analyses, were performed to jointly evaluate the effect of socioeconomic status and leisure sedentary behaviours on GERD risk. RESULTS Three socioeconomic status, including educational attainment (OR 0.46; 95% CI 0.30 to 0.69; p<0.001), average total household income before tax (OR 0.65; 95% CI 0.47 to 0.90; p=0.009) and Townsend Deprivation Index at recruitment (OR 1.60; 95% CI 1.06 to 2.41; p=0.026), were independently and predominately responsible for the genetic causal effect on GERD. In addition, one leisure sedentary behaviour, such as time spent watching television, was independently and predominately responsible for genetic causal effect on GERD (OR 3.74; 95% CI 2.89 to 4.84; p<0.001). No causal effects of social activities and driving on GERD were observed. CONCLUSIONS Genetically predicted Townsend Deprivation Index at recruitment and leisure watching television were causally associated with increased risk of GERD, and age at completion of full-time education and average total household income before tax were causally associated with decreased risk of GERD.
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Affiliation(s)
- Xingji Lian
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yifen Lin
- Department of Cardiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Xiaohui Peng
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yanhui Wang
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Ting He
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Ziyong He
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Wenlong Gu
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Hongwu Wang
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Feng He
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
- Department of Nephrology, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
| | - Yuyu Huang
- Department of Geriatrics, National Key Clinic Specialty, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
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Li H, Zhang S, Zhou S, Bao Y, Cao X, Shen L, Xu B, Gao W, Luo Y. Pepsin enhances glycolysis to promote malignant transformation of vocal fold leukoplakia epithelial cells with dysplasia. Eur Arch Otorhinolaryngol 2023; 280:1841-1854. [PMID: 36380093 PMCID: PMC9988773 DOI: 10.1007/s00405-022-07729-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE The mechanism underlying malignant transformation of vocal fold leukoplakia (VFL) and the precise role of the expression of pepsin in VFL remain unclear. This study aimed to investigate the effects of acidified pepsin on VFL epithelial cell growth and migration, and also identify pertinent molecular mechanisms. METHODS Immunochemistry and Western blotting were performed to measure glucose transporter type 1 (GLUT1), monocarboxylate transporters 4 (MCT4), and Hexokinase-II (HK-II) expressions. Cell viability, cell cycle, apoptosis, and migration were investigated by CCK-8 assay, flow cytometry and Transwell chamber assay, respectively. Glycolysis-related contents were determined using the corresponding kits. Mitochondrial HK-II was photographed under a confocal microscope using Mito-Tracker Red. RESULTS It was found: the expression of pepsin and proportion of pepsin+ cells in VFL increased with the increased dysplasia grade; acidified pepsin enhanced cell growth and migration capabilities of VFL epithelial cells, reduced mitochondrial respiratory chain complex I activity and oxidative phosphorylation, and enhanced aerobic glycolysis and GLUT1 expression in VFL epithelial cells; along with the transfection of GLUT1 overexpression plasmid, 18FFDG uptake, lactate secretion and growth and migration capabilities of VFL epithelial cell were increased; this effect was partially blocked by the glycolysis inhibitor 2-deoxy-glucose; acidified pepsin increased the expression of HK-II and enhanced its distribution in mitochondria of VFL epithelial cells. CONCLUSION It was concluded that acidified pepsin enhances VFL epithelial cell growth and migration abilities by reducing mitochondrial respiratory complex I activity and promoting metabolic reprogramming from oxidative phosphorylation to aerobic glycolysis.
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Affiliation(s)
- Haitong Li
- Department of Otolaryngology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, People's Republic of China
| | - Shasha Zhang
- Department of Otolaryngology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Shuihong Zhou
- Department of Otolaryngology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Yangyang Bao
- Department of Otolaryngology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Xiaojuan Cao
- Department of Otolaryngology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, People's Republic of China
| | - Lifang Shen
- Department of Otolaryngology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Bin Xu
- Department of Otolaryngology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, People's Republic of China
| | - Weimin Gao
- Department of Otolaryngology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, People's Republic of China
| | - Yunzhen Luo
- Department of Otolaryngology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, 314000, People's Republic of China.
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Law AB, Schmitt NC. Laryngeal Anatomy, Molecular Biology, Cause, and Risk Factors for Laryngeal Cancer. Otolaryngol Clin North Am 2023; 56:197-203. [PMID: 37030934 DOI: 10.1016/j.otc.2022.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Laryngeal cancer is declining in incidence in many parts of the world, as smoking becomes a less common habit. However, challenging cases of laryngeal cancer still exist and require expertise from otolaryngologists. This article reviews the relevant anatomy and lymphatic drainage pathways of the larynx because they pertain to cancer spread. The molecular and immune landscapes of laryngeal cancer, which are tightly linked to smoking, are also discussed.
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Affiliation(s)
- Anthony B Law
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, 550 Peachtree Street Northeast, 11th Floor Otolaryngology, Atlanta, GA 30308, USA; Winship Cancer Institute, Emory University School of Medicine, 550 Peachtree Street Northeast, 11th Floor Otolaryngology, Atlanta, GA 30308, USA
| | - Nicole C Schmitt
- Department of Otolaryngology - Head and Neck Surgery, Emory University School of Medicine, 550 Peachtree Street Northeast, 11th Floor Otolaryngology, Atlanta, GA 30308, USA; Winship Cancer Institute, Emory University School of Medicine, 550 Peachtree Street Northeast, 11th Floor Otolaryngology, Atlanta, GA 30308, USA.
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Olson C, Alexander R, Stinnett S. Dysplastic Lesions of the Larynx. Otolaryngol Clin North Am 2023; 56:233-246. [PMID: 37030937 DOI: 10.1016/j.otc.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
There have been many advancements in the clinical and histologic diagnosis of laryngeal dysplasia (LD), but diagnosis still necessitates invasive histologic evaluation. Furthermore, despite improved histologic identification of dysplastic lesions, the exact details of pathophysiologic progression and the risk of malignant transformation is still uncertain. These unknowns create a barrier to establishing an ideal grading and classification system, which prevents the establishment of a precise and consistent treatment paradigm. Identifying these gaps in knowledge serves to highlight where further studies are warranted, ideally focusing on a better understanding of the biological behavior of LD. This would ultimately allow for the creation of a reliable grading and classification system and for the formalization of management and treatment guidelines for LD.
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Johnston N, Samuels TL, Goetz CJ, Arnold LA, Smith BC, Seabloom D, Wuertz B, Ondrey F, Wiedmann TS, Vuksanovic N, Silvaggi NR, MacKinnon AC, Miller J, Bock J, Blumin JH. Oral and Inhaled Fosamprenavir Reverses Pepsin-Induced Damage in a Laryngopharyngeal Reflux Mouse Model. Laryngoscope 2023; 133 Suppl 1:S1-S11. [PMID: 35678265 PMCID: PMC9732152 DOI: 10.1002/lary.30242] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE More than 20% of the US population suffers from laryngopharyngeal reflux. Although dietary/lifestyle modifications and alginates provide benefit to some, there is no gold standard medical therapy. Increasing evidence suggests that pepsin is partly, if not wholly, responsible for damage and inflammation caused by laryngopharyngeal reflux. A treatment specifically targeting pepsin would be amenable to local, inhaled delivery, and could prove effective for endoscopic signs and symptoms associated with nonacid reflux. The aim herein was to identify small molecule inhibitors of pepsin and test their efficacy to prevent pepsin-mediated laryngeal damage in vivo. METHODS Drug and pepsin binding and inhibition were screened by high-throughput assays and crystallography. A mouse model of laryngopharyngeal reflux (mechanical laryngeal injury once weekly for 2 weeks and pH 7 solvent/pepsin instillation 3 days/week for 4 weeks) was provided inhibitor by gavage or aerosol (fosamprenavir or darunavir; 5 days/week for 4 weeks; n = 3). Larynges were collected for histopathologic analysis. RESULTS HIV protease inhibitors amprenavir, ritonavir, saquinavir, and darunavir bound and inhibited pepsin with IC50 in the low micromolar range. Gavage and aerosol fosamprenavir prevented pepsin-mediated laryngeal damage (i.e., reactive epithelia, increased intraepithelial inflammatory cells, and cell apoptosis). Darunavir gavage elicited mild reactivity and no discernable protection; aerosol protected against apoptosis. CONCLUSIONS Fosamprenavir and darunavir, FDA-approved therapies for HIV/AIDS, bind and inhibit pepsin, abrogating pepsin-mediated laryngeal damage in a laryngopharyngeal reflux mouse model. These drugs target a foreign virus, making them ideal to repurpose. Reformulation for local inhaled delivery could further improve outcomes and limit side effects. LEVEL OF EVIDENCE NA. Laryngoscope, 133:S1-S11, 2023.
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Affiliation(s)
- Nikki Johnston
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI
- Department of Microbiology and Immunology, Medical College of Wisconsin
| | - Tina L. Samuels
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI
| | | | - Leggy A. Arnold
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin, Milwaukee, WI
| | - Brian C. Smith
- Department of Biochemistry, Medical College of Wisconsin
| | - Donna Seabloom
- Department of Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | - Beverly Wuertz
- Department of Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | - Frank Ondrey
- Department of Otolaryngology Head and Neck Surgery, University of Minnesota, Minneapolis, MN
| | | | - Nemanja Vuksanovic
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin, Milwaukee, WI
| | - Nicholas R. Silvaggi
- Department of Chemistry and Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin, Milwaukee, WI
| | | | - James Miller
- Department of Pathology, Medical College of Wisconsin
| | - Jonathan Bock
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Joel H. Blumin
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI
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The regulatory mechanism of HSP70 in endoplasmic reticulum stress in pepsin-treated laryngeal epithelium cells and laryngeal cancer cells. Aging (Albany NY) 2022; 14:8486-8497. [DOI: 10.18632/aging.204356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022]
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Xiao S, Li J, Zheng H, Li X, Yang H, Zhang J, Peng X, Zhou S, Zhao C, Chen D, Xiao X, Shi L, Huangfu H, Tao Z, Chen X, Liu Y, Qu S, Wang G, Chen T, Cui X, Tian L, Zhou W, Fang H, Huang Y, Yu G, Lin Z, Tang L, He J, Ma R, Yu Z. Awareness about laryngopharyngeal reflux disease among Chinese otolaryngologists: a nationwide survey. BMJ Open 2022; 12:e058852. [PMID: 35732392 PMCID: PMC9226935 DOI: 10.1136/bmjopen-2021-058852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the status of the current knowledge about laryngopharyngeal reflux disease (LPRD) among Chinese otolaryngologists. DESIGN Multi-centre cross-sectional survey. SETTING 220 medical centres in different regions of China. PARTICIPANTS A total of 2254 otolaryngologists from 220 medical centres in China who were successfully on-site surveyed between November 2019 and December 2020. MAIN OUTCOME MEASURES Awareness about LPRD included knowledge about risk factors, symptoms, laryngoscope signs, related diseases, current diagnostic methods and treatments. RESULTS The percentage of participants who had heard of LPRD was 96.4%, with academic conferences as the most common source of information (73.3%). The most commonly known risk factor, symptom, laryngoscope sign, related disease, diagnostic method and treatment were alcohol consumption (44.0%), pharyngeal foreign body sensation (66.9%), hyperaemia (52.4%), pharyngolaryngitis (54.8%), pH monitoring (47.6%) and medication (82.1%), respectively. Only 28.3% of all participants knew that 24 h pH or multichannel intraluminal impedance pH monitoring was the most accurate diagnostic test. As many as 73.1% of all participants knew that proton pump inhibitors were the first-line treatment drugs. An analysis of the overall status of awareness using a scoring system suggested that otolaryngologists were better aware owing to more access, working at 3A hospitals, and postgraduate or above educational background (all p<0.05). CONCLUSION Although the majority of Chinese otolaryngologists had heard of LPRD, their overall awareness about the disease was not encouraging. More efforts are needed to increase the knowledge about LPRD among this group of physicians. TRIAL REGISTRATION NUMBER ChiCTR1900025581.
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Affiliation(s)
- Shuifang Xiao
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Jinrang Li
- Department of Otolaryngology, Head and Neck Surgery, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongliang Zheng
- Department of Otolaryngology, Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiangping Li
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hui Yang
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Junbo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Xiaoxia Peng
- Clinical Epidemiology and Evidence-based Medicine Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shuihong Zhou
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chen Zhao
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Donghui Chen
- Department of Otolaryngology, Head and Neck Surgery, Jiangsu Province Hospital, Nanjing, Jiangsu, China
| | - Xuping Xiao
- Department of Otolaryngology, Head and Neck Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Li Shi
- Department of Otolaryngology, Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Hui Huangfu
- Department of Otolaryngology, Head and Neck Surgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhenfeng Tao
- Department of Otolaryngology, Head and Neck Surgery, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Xiong Chen
- Department of Otolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yehai Liu
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Shenhong Qu
- Department of Otolaryngology, Head and Neck Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Guangke Wang
- Department of Otolaryngology, Head and Neck Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Ting Chen
- Department of Otolaryngology, Head and Neck Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Xiaobo Cui
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Linli Tian
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Wensheng Zhou
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hongyan Fang
- Department of Otolaryngology, Head and Neck Surgery, Chongqing General Hospital, Chongqing, China
| | - Yongwang Huang
- Department of Otolaryngology, Head and Neck Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guodong Yu
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Zhenqun Lin
- Department of Otolaryngology, Head and Neck Surgery, Hainan Provincial People's Hospital, Haikou, Hainan, China
| | - Liang Tang
- Department of Otolaryngology, Head and Neck Surgery, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Jian He
- Department of Otolaryngology, Head and Neck Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Ruixia Ma
- Department of Otolaryngology, Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhaoyan Yu
- Department of Otolaryngology, Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong Provincial ENT Hospital Affiliated to Shandong University, Jinan, Shandong, China
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Varelas EA, Houser TK, Husain IA. Laryngopharyngeal Reflux: Effect of Race and Insurance Status on Symptomology. Ann Otol Rhinol Laryngol 2022; 132:545-550. [PMID: 35695133 DOI: 10.1177/00034894221100025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Laryngopharyngeal reflux (LPR) is an extraesophageal variant of gastroesophageal reflux disease associated with intermittent dysphonia, throat-clearing, and chronic cough. This study aims to evaluate the impact of race and insurance status on symptoms often attributable to LPR. METHODS Retrospective review of all patients with suspected LPR from 2017 to 2019 was performed at a tertiary care center. The diagnostic criteria comprised evaluation by a fellowship trained laryngologist and Reflux Symptom Index (RSI) scores. Demographics, patient history, and insurance status were recorded. Descriptive statistics were calculated for each parameter using SPSS version 22. RESULTS A total of 170 patients (96 White, 44 Black, 26 Latinx, 4 Asian) were included in this study. About 57.1% had private insurance, 30.6% had Medicare, and 11.8% had Medicaid. Black and Latinx patients demonstrated higher RSI scores (26.67 ± 8.61, P = .017) when compared to their White and Asian counterparts. RSI scores between all 3 insurance types also varied significantly (P = .035). Medicaid patients reported higher RSI scores (28.65 ± 10.09, P = .028), while private insurance patients reported significantly lower scores (23.75 ± 7.88, P = .03). Controlling for insurance type eliminates the statistically significant association between RSI scores and Black and Latinx patients. Particularly, within the Medicaid group, Black, Latinx, and White patients did not have statistically different RSI scores. CONCLUSIONS Black and Latinx patients presented with higher RSI scores than White and Asian patients. Similarly, Medicaid patients reported higher RSI scores than the Non-Medicaid cohort. These findings suggest that access to appropriate healthcare, due to varied insurance coverage and socioeconomic, may potentially influence symptoms attributed to LPR.
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Affiliation(s)
| | - Thomas K Houser
- Rush University Medical Center, Chicago, IL, USA.,UT Southwestern Medical Center, Dallas, TX, USA
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Han H, Lyu Q, Liang Y. Different Characteristics of Oropharyngeal pH Changes in Different Laryngeal Diseases. EAR, NOSE & THROAT JOURNAL 2022:1455613221081568. [PMID: 35239431 DOI: 10.1177/01455613221081568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To evaluate the different characteristics of oropharyngeal pH changes in patients with different laryngeal diseases. METHODS A retrospective analysis was performed. The clinical data of 262 patients were summarized. The patients were divided into 4 groups. Group 1 included 123 patients with suspected laryngopharyngeal reflux disease (LPRD). Group 2 included 45 patients with vocal cord polyps. Group 3 included 40 patients with vocal cord leukoplakia. Group 4 included 54 patients with laryngeal carcinoma. Their reflux symptom indexes (RSIs), reflux finding scores (RFSs), and Dx-pH monitoring results were compared. RESULTS In total, 235 patients had abnormal RSI/RFS, 90 patients had abnormal Ryan scores. The rate of abnormal RSI/RFS of Group 1 was significantly higher than that of Group 4 (P = .001). Significant differences of the rates of abnormal Ryan scores existed between Groups 2 and 4 (P = .021) and Groups 3 and 4 (P = .027). There were obvious differences in upright Ryan scores between Groups 1 and 2 (P = .013), Groups 1 and 3 (P = .002), Groups 2 and 4 (P = .046), and Groups 3 and 4 (P = .009). There were significant differences in time percentage of oropharyngeal pH of upright 5.5∼6.5 and supine 5.0∼6.5 between Groups 1 and 3 as well as Groups 1 and 4 (upright: Groups 1 and 3: P = .017; Groups 1 and 4: P = .019. Supine: Groups 1 and 3: P = .018; Groups 1 and 4: P = .023). CONCLUSIONS There were different oropharyngeal pH characteristics in patients with different laryngeal diseases, which indicated laryngopharyngeal reflux may play different roles in different diseases through various patterns. Patients with vocal cord polyps, vocal cord leukoplakia, and laryngeal carcinoma had more and different patterns of oropharyngeal pH change than patients with LPRD. Patients with vocal cord polyps and vocal cord leukoplakia had more severe acid oropharyngeal pH change episodes than patients with laryngeal carcinoma.
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Affiliation(s)
- Honglei Han
- Department of Otolaryngology-Head and Neck Surgery, 36635China-Japan Friendship Hospital, Beijing, China
| | - Qiuping Lyu
- Department of Otolaryngology-Head and Neck Surgery, 36635China-Japan Friendship Hospital, Beijing, China
| | - Yan Liang
- Department of Gastroesophageal Surgery, 422480PLA Rocket Force Characteristic Medical Center, Beijing, China
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Huang Y, Gu M, Wu Q, Zhu J, Wu J, Wang P, Wang M, Luo J. Is Laryngeal Squamous Cell Carcinoma Related to Helicobacter pylori?. Front Oncol 2022; 12:790997. [PMID: 35155235 PMCID: PMC8832492 DOI: 10.3389/fonc.2022.790997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/10/2022] [Indexed: 12/16/2022] Open
Abstract
Background Laryngeal carcinoma is a primary malignant tumor originating from the laryngeal mucosa. In recent years, an increasing number of studies have confirmed that Helicobacter pylori may play a role in the occurrence and development of laryngeal cancer. We conducted a systematic review and meta-analysis to identify and emphasize the relationship between laryngeal cancer and Helicobacter pylori infection. Methods We actively searched for systematic reviews of PubMed, Embase, Web of Science, and Cochrane libraries to select studies that met the recommended guidelines. A total of 1756 patients with laryngeal cancer were included in this study to assess the association of Helicobacter pylori in the larynx with laryngeal cancer. A subassessment of the risk of bias for each study that met the inclusion criteria was carried out. To illustrate the reasons for heterogeneity, we performed a subgroup analysis to determine the type of study, the quality of the article, the diagnostic method, and the impact of exposure factors. Results The meta-analysis included a total of 17 case-control studies on the association between Helicobacter pylori in the larynx and laryngeal cancer. Our meta-analysis showed that Helicobacter pylori infection in the larynx significantly increased the risk of malignant tumors in the larynx (odds ratio, 2.96; 95% CI, 1.83-4.78; P<0.00001; I2 = 86%). They still existed when we controlled for patients’ exposure to smoking factors (odds ratio, 3.86; 95% CI, 1.89–7.88). Conclusion This systematic review and meta-analysis showed an association between Helicobacter pylori and laryngeal cancer. These findings are consistent with the understanding that chronic inflammatory tissue insult may lead to the development of malignancy. Controlling risk factors will help us identify patients with an increased risk of laryngeal cancer.
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Affiliation(s)
- Yan Huang
- Department of Radiotherapy, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China.,Department of Head and Neck Surgery, Graduate School of Dalian Medical University, Dalian, China
| | - Min Gu
- Department of Stomatology, Affiliated Third Hospital of Soochow University, The First People's Hospital of Changzhou City, Changzhou, China
| | - Qi Wu
- Department of Clinical Medicine, Heze Medical College, Heze, China
| | - Juanfen Zhu
- Department of Head and Neck Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jian Wu
- Department of Head and Neck Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Peipei Wang
- Department of Stomatology, Affiliated Third Hospital of Soochow University, The First People's Hospital of Changzhou City, Changzhou, China
| | - Meihua Wang
- Department of Pathology, Changzhou Tumor Hospital, Affiliated to Soochow University, Changzhou, China
| | - Judong Luo
- Department of Radiotherapy, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
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Romanenko SG, Kryukov AI, Pronina NA, Pavlikhin OG, Yarovaya LA. [Screening for laryngeal disease in patients with gastroesophageal reflux disease]. Vestn Otorinolaringol 2022; 87:14-18. [PMID: 36580504 DOI: 10.17116/otorino20228706114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To improve the diagnosis of laryngeal disease in patients with gastroesophageal reflux disease (GERD). MATERIAL AND METHODS 171 patients (89 (52%) men, 82 (48%) women) with non-erosive (39 (23%) people) and erosive (132 (77%) people) forms of GERD were examined. None of the patients made active complaints about the condition of the larynx and pharynx. The examination included a questionnaire, examination by an otorhinolaryngologist, and videoendolaryngoscopy. RESULTS The survey revealed the presence of symptoms of otorhinolaryngological pathology in 74% of patients. Videolaryngoscopy revealed no laryngeal pathology in 55 (32%) patients, and signs of GERD-associated laryngitis were detected in 116 (68%) patients. The most common pathology was pachydermia in interarytenoid region - in 89 people, laryngeal granuloma was detected in 7 patients, leukoplakia - in 2 patients, chronic edematous polypous laryngitis - in 2 patients, benign laryngeal formations - in 9 patients. In patients with GERD (erosive and non-erosive forms), an asymptomatic course of chronic laryngitis associated with this pathology was observed in 44% of cases. In 52% of patients, pachydermia in interarytenoid region was diagnosed, of which every second had pronounced hyperplasia and folding of the mucous membrane in interarytenoid region, which must be differentiated from laryngeal cancer (in this case, patients should be under the dynamic supervision of an otorhinolaryngologist). Other precancerous formations of the larynx (granulomas and leukoplakia) were found in 5% of patients. Benign neoplasms of the larynx (polyps and cysts) were also detected in 5% of cases. CONCLUSIONS Despite the high frequency of detection of otorhinolaryngological diseases in the examined patients with gastroesophageal reflux disease, none of the patients presented complaints related to the pathology of the larynx, which indicates the need for active detection of this pathology in this category of patients by questioning, questioning, as well as examination by an otorhinolaryngologist.
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Affiliation(s)
- S G Romanenko
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A I Kryukov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - N A Pronina
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Polyclinic No. 2 of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | - O G Pavlikhin
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - L A Yarovaya
- Polyclinic No. 2 of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
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Laryngeal cancers in paediatric and young adult patients: epidemiology, biology and treatment. Curr Opin Otolaryngol Head Neck Surg 2021; 30:145-153. [PMID: 34740227 DOI: 10.1097/moo.0000000000000766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW The aim of thi study was to review the recent literature on epidemiology, biology and treatment of laryngeal cancer in paediatric and young adult patients. RECENT FINDINGS Epidemiological studies reported that 2-10% of patients with laryngeal cancer are younger than 40-year-old, while the prevalence of laryngeal cancer remains unknown in the paediatric population. The development of laryngeal cancer in young adults is multifactorial and may be linked to common carcinogens (tobacco and alcohol), occupational factors, laryngopharyngeal reflux, immunosuppression, human papillomavirus infection and genetic polymorphism. A substantial number of cohort studies reported a significant lower proportion of drinkers and smokers in young populations with laryngeal cancer, supporting the higher prevalence of chromosomal losses or abnormalities predisposing to cancer in this group. The development of laryngeal cancer in paediatric patients is strongly associated with genetic syndromes with DNA repair abnormalities. The pathological, clinical and survival outcome differences between young and old patient groups vary significantly between studies, depending on epidemiological, genetic features and therapeutic strategies used. SUMMARY Paediatric and adult populations with laryngeal cancer present different clinical, pathological and survival outcomes. In the adult population, the patient age at the time of disease development underlies genetic and etiological differences with different mutation patterns between young and old patients, the latter being more frequently individuals with a history of tobacco and alcohol abuse. The differences between age groups regarding stage of cancer at initial presentation, as well as clinical and survival outcomes, are unclear, which may be due to demographic, ethnicity and population genetic differences.
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Guo Z, Jiang J, Wu H, Zhu J, Zhang S, Zhang C. Salivary peptest for laryngopharyngeal reflux and gastroesophageal reflux disease: A systemic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26756. [PMID: 34397878 PMCID: PMC8360476 DOI: 10.1097/md.0000000000026756] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/06/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A rapid lateral flow test (Peptest) to detect pepsin in saliva/sputum has been considered as a valuable method for diagnosing laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD). The aim of this meta-analysis is to analyze the utility of Peptest for diagnosis of LPR and GERD. METHODS PubMed, EMBASE, and the Cochran Library (from January 1980 to 26 January 2020) were searched for pepsin in saliva for LPR/GERD diagnosis. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve data were summarized to examine the accuracy. RESULTS A total of 16 articles that included 2401 patients and 897 controls were analyzed. The pooled sensitivity and specificity for the diagnosis of GERD/LPR with Peptest were 62% (95% confidence interval [CI] 49%-73%) and 74% (95% CI 50%-90%), respectively. The summarized diagnostic odds ratio and area under the curve were 5.0 (95% CI 2-19) and 0.70 (95% CI 0.66-0.74), respectively. CONCLUSION Peptest shows moderate diagnostic value for LPR and GERD. More studies with standard protocols should be done to verify its usefulness.
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Affiliation(s)
- Zihao Guo
- Department of Gastroenterology, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China
| | - Jiali Jiang
- Department of Gastroenterology, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Department of Cardiovascular diseases, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China
| | - Jinxia Zhu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing, China
- Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Beijing, China
| | - Chuan Zhang
- Department of Gastroenterology, Beijing Tong Ren Hospital, Capital Medical University, Beijing, China
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Gluvajić D, Šereg-Bahar M, Jerin A, Janša R, Hočevar-Boltežar I. The Impact of Laryngopharyngeal Reflux on Occurrence and Clinical Course of Recurrent Respiratory Papillomatosis. Laryngoscope 2021; 132:619-625. [PMID: 34338331 DOI: 10.1002/lary.29793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Laryngopharyngeal reflux (LPR) has been proposed both as a trigger for recurrent respiratory papillomatosis (RRP) onset and as a factor favoring an aggressive clinical course. STUDY DESIGN In this prospective study, 106 participants were recruited within a period of 24 months at the Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana. METHODS This study compared a group of RRP patients (N = 36) with a group of LPR patients (N = 28) and a group of healthy participants (N = 42) based on Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and saliva analyses (pH, pepsin concentration, bile acid concentration, and pepsin enzymatic activity). RESULTS The RRP group compared to the LPR group showed a statistically significant difference only in RSI and RFS scores, while the RRP group compared to healthy controls showed significantly higher values in all tested parameters (RSI score, RFS, saliva pH, pepsin concentration, bile acids concentration, pepsin enzymatic activity). CONCLUSIONS LPR is common in RRP patients and significantly more prevalent compared to healthy controls. Our results show that saliva analyses are a better office-based tool than RSI questionnaires and RFS scores for diagnosing LPR in RRP patients. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2021.
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Affiliation(s)
- Daša Gluvajić
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Maja Šereg-Bahar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Aleš Jerin
- Institute of Chemistry and Biochemistry, University Medical Centre, Ljubljana, Slovenia
| | - Rado Janša
- Clinical Department of Gastroenterology, University Medical Centre, Ljubljana, Slovenia
| | - Irena Hočevar-Boltežar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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22
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Wang SM, Freedman ND, Katki HA, Matthews C, Graubard BI, Kahle LL, Abnet CC. Gastroesophageal reflux disease: A risk factor for laryngeal squamous cell carcinoma and esophageal squamous cell carcinoma in the NIH-AARP Diet and Health Study cohort. Cancer 2021; 127:1871-1879. [PMID: 33615447 PMCID: PMC8406665 DOI: 10.1002/cncr.33427] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prior studies have suggested that gastroesophageal reflux disease (GERD) may be associated with risk of squamous cancers of the larynx and esophagus; however, most of these studies have had methodological limitations or insufficient control for potential confounders. METHODS We prospectively examined the association between GERD and esophageal adenocarcinoma (EADC), esophageal squamous cell carcinoma (ESCC), and laryngeal squamous cell carcinoma (LSCC) in 490,605 participants of the NIH-AARP Diet and Health Study cohort who were 50-71 years of age at baseline. Exposure to risk factors were obtained from the baseline questionnaire. GERD diagnosis was extracted among eligible participants via linkage to Medicare diagnoses codes and then multiply imputed for non-Medicare-eligible participants. Hazard ratios (HRs) and 95% CIs of GERD were computed using Cox regression. RESULTS From 1995 to 2011, we accrued 931 cases of EADC, 876 cases of LSCC, and 301 cases of ESCC in this cohort and estimated multivariable-adjusted HRs of 2.23 (95% CI, 1.72-2.90), 1.91 (95% CI, 1.24-2.94), and 1.99 (95% CI, 1.39-2.84) for EADC, LSCC, and ESCC, respectively. The associations were independent of sex, smoking status, alcohol intake, and follow-up time periods. We estimated that among the general population in the United States, 22.04% of people aged 50-71 years suffered from GERD. Using risk factor distributions for the United States from national survey data, 16.92% of LSCC cases and 17.32% of ESCC cases among individuals aged 50-71 years were estimated to be associated with GERD. CONCLUSION GERD is a common gastrointestinal disorder, but future prospective studies are needed to replicate our findings. If replicated, they may inform clinical surveillance of GERD patients and suggest new avenues for prevention of these malignancies.
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Affiliation(s)
- Shao-Ming Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Hormuzd A Katki
- Biostatistics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Charles Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Barry I Graubard
- Biostatistics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Lisa L Kahle
- Information Management Services Inc, Calverton, Maryland
| | - Christian C Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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23
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A roadmap of six different pathways to improve survival in laryngeal cancer patients. Curr Opin Otolaryngol Head Neck Surg 2021; 29:65-78. [PMID: 33337612 DOI: 10.1097/moo.0000000000000684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Laryngeal cancer continues to require improvement in earlier stage diagnosis and better imaging delineation of disease, and hence 'more evidence-based' selection of treatment, as recent evidence suggests that related mortality, in the last decades, has not significantly decreased worldwide. Even though the reasons are not fully understood, there persists an urgency for a review and development of future strategies to embrace such clinical and diagnostic challenges from a political, societal, as well as scientific and clinical points of view. RECENT FINDINGS This review of the published literature suggests that survival improvement in laryngeal cancer may be achieved by fuelling and combining at least some or all of six targeted agendas: documentation of disease global incidence and national burden monitoring; development and implementation of high-quality cancer registries; education on risk factors and hazardous habits associated with laryngeal cancer for the general population; active modification of proven at-risk population lifestyles; centralization of treatment; and use of machine learning of gathered 'big data' and their integration into approaches for the optimization of prevention and treatments strategies. SUMMARY Laryngeal cancer should be tackled on several fronts, commencing with disease monitoring and prevention, up to treatment optimisation. Available modern resources offer the possibility to generate significant advances in laryngeal cancer management. However, each nation needs to develop a comprehensive approach, which is an essential prerequisite to obtain meaningful improvement on results.
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24
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Yanes M, Santoni G, Maret-Ouda J, Ness-Jensen E, Färkkilä M, Lynge E, Pukkala E, Romundstad P, Tryggvadóttir L, -Chelpin MVE, Lagergren J. Survival after antireflux surgery versus medication in patients with reflux oesophagitis or Barrett's oesophagus: multinational cohort study. Br J Surg 2021; 108:864-870. [PMID: 33724340 DOI: 10.1093/bjs/znab024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim was to examine the hypothesis that antireflux surgery with fundoplication improves long-term survival compared with antireflux medication in patients with reflux oesophagitis or Barrett's oesophagus. METHOD Individuals aged between 18 and 70 years with reflux oesophagitis or Barrett's oesophagus (intestinal metaplasia) documented from in-hospital and specialized outpatient care were selected from national patient registries in Denmark, Finland, Iceland, and Sweden from 1980 to 2014. The study investigated all-cause mortality and disease-specific mortality, comparing patients who had undergone open or laparoscopic antireflux surgery with fundoplication versus those using antireflux medication. Multivariable Cox regression analysis was used to estimate hazard ratios (HRs) with 95 per cent confidence intervals for all-cause mortality and disease-specific mortality, adjusted for sex, age, calendar period, country, and co-morbidity. RESULTS Some 240 226 patients with reflux oesophagitis or Barrett's oesophagus were included, of whom 33 904 (14.1 per cent) underwent antireflux surgery. The risk of all-cause mortality was lower after antireflux surgery than with use of medication (HR 0.61, 95 per cent c.i. 0.58 to 0.63), and lower after laparoscopic (HR 0.56, 0.52 to 0.60) than open (HR 0.80, 0.70 to 0.91) surgery. After antireflux surgery, mortality was decreased from cardiovascular disease (HR 0.58, 0.55 to 0.61), respiratory disease (HR 0.62, 0.57 to 0.66), laryngeal or pharyngeal cancer (HR 0.35, 0.19 to 0.65), and lung cancer (HR 0.67, 0.58 to 0.80), but not from oesophageal cancer (HR 1.05, 0.87 to 1.28), compared with medication, The decreased mortality rates generally remained over time. CONCLUSION In patients with reflux oesophagitis or Barrett's oesophagus, antireflux surgery is associated with lower mortality from all causes, cardiovascular disease, respiratory disease, laryngeal or pharyngeal cancer, and lung cancer, but not from oesophageal cancer, compared with antireflux medication.
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Affiliation(s)
- M Yanes
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - G Santoni
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J Maret-Ouda
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - E Ness-Jensen
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim/Levanger, Norway.,Medical Department, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - M Färkkilä
- Clinic of Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - E Lynge
- Nykøbing Falster Hospital, University of Copenhagen, Copenhagen, Denmark
| | - E Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - P Romundstad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim/Levanger, Norway
| | - L Tryggvadóttir
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - J Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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25
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Weakly Acidic Bile Is a Risk Factor for Hypopharyngeal Carcinogenesis Evidenced by DNA Damage, Antiapoptotic Function, and Premalignant Dysplastic Lesions In Vivo. Cancers (Basel) 2021; 13:cancers13040852. [PMID: 33670587 PMCID: PMC7923205 DOI: 10.3390/cancers13040852] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/13/2021] [Accepted: 02/14/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The etiologic role of biliary reflux in hypopharyngeal cancer is supported by clinical data. Although, reflux episodes often occur at pH 4.0, they can also occur at weakly acidic pH (5.5–6.0). The carcinogenic effect of bile at strongly acidic pH (pH 3.0) was recently documented in vivo. Here, we provide novel in vivo evidence that a weakly acidic pH of 5.5, similarly to a strongly acidic pH of 3.0, increases the risk of bile-related hypopharyngeal neoplasia. We document that chronic exposure of hypopharyngeal mucosa to bile at pH 5.5 promotes premalignant lesions with DNA damage, NF-κB activation, and deregulated mRNA and miRNA phenotypes, including Bcl-2 and miR-451a. The oncogenic effects of bile over a wider pH range suggests that antacid therapy may be insufficient to fully modify the effects of a bile induced oncogenic effect. Abstract Background: There is recent in vivo discovery documenting the carcinogenic effect of bile at strongly acidic pH 3.0 in hypopharynx, while in vitro data demonstrate that weakly acidic bile (pH 5.5) has a similar oncogenic effect. Because esophageal refluxate often occurs at pH > 4.0, here we aim to determine whether weakly acidic bile is also carcinogenic in vivo. Methods: Using 32 wild-type mice C57B16J, we performed topical application of conjugated primary bile acids with or without unconjugated secondary bile acid, deoxycholic acid (DCA), at pH 5.5 and controls, to hypopharyngeal mucosa (HM) twice per day, for 15 weeks. Results: Chronic exposure of HM to weakly acidic bile, promotes premalignant lesions with microinvasion, preceded by significant DNA/RNA oxidative damage, γH2AX (double strand breaks), NF-κB and p53 expression, overexpression of Bcl-2, and elevated Tnf and Il6 mRNAs, compared to controls. Weakly acidic bile, without DCA, upregulates the “oncomirs”, miR-21 and miR-155. The presence of DCA promotes Egfr, Wnt5a, and Rela overexpression, and a significant downregulation of “tumor suppressor” miR-451a. Conclusion: Weakly acidic pH increases the risk of bile-related hypopharyngeal neoplasia. The oncogenic properties of biliary esophageal reflux on the epithelium of the upper aerodigestive tract may not be fully modified when antacid therapy is applied. We believe that due to bile content, alternative therapeutic strategies using specific inhibitors of relevant molecular pathways or receptors may be considered in patients with refractory GERD.
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26
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Costa SNDL, Fernandes FCGDM, Souza DLBD, Bezerra HDS, Santos EGDO, Barbosa IR. Incidence and mortality by larynx cancer in Central and South America. ACTA ACUST UNITED AC 2021; 42:e20190469. [PMID: 33566944 DOI: 10.1590/1983-1447.2021.20190469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe how the incidence and mortality trends for laryngeal cancer in South and Central American countries. METHODS Time series study, with incidence data from the International Agency for Research on Cancer, from 1990 to 2012 and mortality data from 17 countries of the World Health Organization, from 1995 to 2013. The trend was analyzed by Joinpoint regression. RESULTS The highest incidence rate for laryngeal cancer was in Brazil, with 5.9 new cases per 100,000 men, and the highest mortality rate in Uruguay with 4.2 deaths per 100,000 men. The incidence ratio between genders ranged from 4: 1 (Colombia) to 12: 1 (Ecuador). The mortality ratio between the sexes ranged from 4: 1 (Peru) to 14: 1 (Uruguay). CONCLUSION Most countries had low incidence rates and reduced mortality in Latin America.
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Affiliation(s)
- Suellen Nadine de Lima Costa
- Universidade Federal do Rio Grande do Norte (UFRN), Faculdade de Ciências da Saúde do Trairi. Santa Cruz, Rio Grande do Norte, Brasil
| | | | - Dyego Leandro Bezerra de Souza
- Universidade Federal do Rio Grande do Norte (UFRN), Centro de Ciências da Saúde, Programa de Pós-graduação em Saúde Coletiva, Natal, Rio Grande do Norte, Brasil
| | - Héllyda de Souza Bezerra
- Universidade Federal do Rio Grande do Norte (UFRN), Centro de Ciências da Saúde, Programa de Pós-graduação em Saúde Coletiva, Natal, Rio Grande do Norte, Brasil
| | - Emelynne Gabrielly de Oliveira Santos
- Universidade Federal do Rio Grande do Norte (UFRN), Centro de Ciências da Saúde, Programa de Pós-graduação em Saúde Coletiva, Natal, Rio Grande do Norte, Brasil
| | - Isabelle Ribeiro Barbosa
- Universidade Federal do Rio Grande do Norte (UFRN), Centro de Ciências da Saúde, Programa de Pós-graduação em Saúde Coletiva, Natal, Rio Grande do Norte, Brasil
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27
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Liu D, Qian T, Sun S, Jiang JJ. Laryngopharyngeal Reflux and Inflammatory Responses in Mucosal Barrier Dysfunction of the Upper Aerodigestive Tract. J Inflamm Res 2021; 13:1291-1304. [PMID: 33447069 PMCID: PMC7801919 DOI: 10.2147/jir.s282809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/16/2020] [Indexed: 12/29/2022] Open
Abstract
The upper aerodigestive tract (UAT) is the first line of defense against environmental stresses such as antigens, microbes, inhalants, foods, etc., and mucins, intracellular junctions, epithelial cells, and immune cells are the major constituents of this defensive mucosal barrier. Laryngopharyngeal reflux (LPR) is recognized as an independent risk factor for UAT mucosal disorders, and in this review, we describe the components and functions of the mucosal barrier and the results of LPR-induced mucosal inflammation in the UAT. We discuss the interactions between the refluxate and the mucosal components and the mechanisms through which these damaging events disrupt and alter the mucosal barriers. In addition, we discuss the dynamic alterations in the mucosal barrier that might be potential therapeutic targets for LPR-induced disorders.
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Affiliation(s)
- Danling Liu
- Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China
| | - Tingting Qian
- Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China
| | - Shan Sun
- Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China
| | - Jack J Jiang
- Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China.,Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of Wisconsin Medical School, Madison, WI 53792-7375, USA
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28
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Lechien JR, Saussez S, Cammaroto G, Hans S. Laryngopharyngeal reflux and head and neck cancers. Am J Otolaryngol 2021; 42:102815. [PMID: 33139088 DOI: 10.1016/j.amjoto.2020.102815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jerome R Lechien
- Department of human Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, UVSQ, Paris Saclay University, Paris, France.
| | - Sven Saussez
- Department of human Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Belgium
| | | | - Stephane Hans
- Department of human Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Department of Otorhinolaryngology-Head and Neck Surgery, Foch Hospital, UVSQ, Paris Saclay University, Paris, France
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29
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Wang JY, Peng T, Zhao LL, Feng GJ, Liu YL. Poor consistency between reflux symptom index and laryngopharyngeal pH monitoring in laryngopharyngeal reflux diagnosis in Chinese population. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:25. [PMID: 33553318 PMCID: PMC7859794 DOI: 10.21037/atm-20-4783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background It is unknown whether the reflux symptom index (RSI) can replace pH monitoring as a diagnostic tool for laryngopharyngeal reflux (LPR) in Chinese people. The relationships between reflux parameters and LPR symptoms also require further research. Methods A total of 216 Chinese patients underwent laryngopharyngeal pH monitoring and filled out an RSI questionnaire. Laryngopharyngeal pH monitoring indicated a diagnosis of LPR for patients with 7 or more episodes of reflux or a reflex area index (RAI) of 6.3 or more. The RSI questionnaire indicated a diagnosis of LPR for patients with RSI scores of 14 or higher. Results Of the 216 patients, 85 were diagnosed with LPR as assessed by the RSI, and 72 were diagnosed with LPR through laryngopharyngeal pH monitoring. The Cohen's kappa coefficient comparing LPR diagnosis consistency between RSI score and laryngopharyngeal pH monitoring was 0.133 (P=0.007). This indicated the two diagnostic methods were consistent to a low degree; the total consistency rate was only 59.7% (129/216). The sensitivity of the RSI was 48.6% (35/72), and its specificity was 82.5% (94/114). For convenience, we named the nine symptom groups in the RSI sequentially as P1-P9. P1, P2, P3, P5, P6, and P7 were all correlated with at least one reflux parameter (P<0.05), but P4, P8, and P9 were not correlated with any reflux parameters (P>0.05). A total of 72 patients were diagnosed using pH monitoring, the gold standard for LPR diagnosis. The most common symptoms of LPR were found to be P9, P3, P8, P7, and P2 in these patients. The symptoms that most seriously affected patients were P9, P8, P3, P7, and P2. Conclusions The consistency in diagnosis of LPR between the RSI and laryngopharyngeal pH monitoring was poor, meaning the RSI is not a suitable LPR initial screening tool and cannot replace pH monitoring. Additionally, reflux symptoms P4, P8, and P9 were not correlated with any reflux parameters. The most prevalent LPR symptom was P9, followed by P3, P8, P7, and P2. The most severe symptom was also P9, followed by P8, P3, P7, and P2.
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Affiliation(s)
- Jun-Yao Wang
- Department of Gastroenterology, Peking University People's Hospital, Beijing, China
| | - Tao Peng
- Department of Gastroenterology, Peking University People's Hospital, Beijing, China
| | - Li-Li Zhao
- Department of Gastroenterology, Peking University People's Hospital, Beijing, China
| | - Gui-Jian Feng
- Department of Gastroenterology, Peking University People's Hospital, Beijing, China
| | - Yu-Lan Liu
- Department of Gastroenterology, Peking University People's Hospital, Beijing, China
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30
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Tan J, Li L, Huang X, Yang C, Liang X, Zhao Y, Xie J, Chen R, Wang D, Xie S. Associations between gastro-oesophageal reflux disease and a range of diseases: an umbrella review of systematic reviews and meta-analyses. BMJ Open 2020; 10:e038450. [PMID: 33380477 PMCID: PMC7780720 DOI: 10.1136/bmjopen-2020-038450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Numerous meta-analyses have revealed the association between gastro-oesophageal reflux disease (GORD) and a range of diseases; however, the certainty of the evidence remains unclear. This study aimed to summarise and assess the certainty of evidence derived from meta-analyses. METHODS Embase, PubMed, Web of Science, Cochrane Databases of Systematic Reviews, CNKI and Wangfang databases from their inception to 22 February 2020 were queried for systematic reviews and meta-analyses on the association between GORD and various diseases. The methodological quality of the included studies was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), and evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Statistical analysis was conducted using Stata V.15. RESULTS Ten publications with associations between GORD and different types of diseases were included. There was high heterogeneity (I2 >75%) among seven independent meta-analyses. Evidence for publication bias in two independent meta-analyses was also observed. According to the AMSTAR 2 approach, the methodological quality was high for 20% of meta-analyses, moderate for 10%, low for 40% and critically low for 30%. Based on GRADE approach, the certainty of evidence was high for the association between GORD and higher risk of chronic obstructive pulmonary disease (COPD) exacerbation (OR 5.37; 95% CI 2.71 to 10.64) and higher prevalence of oesophageal adenocarcinoma (OR 4.57; 95% CI 3.89 to 5.36), and it was moderate for the association between GORD and higher chronic rhinosinusitis prevalence (OR 2.16; 95% CI 1.37 to 3.48). CONCLUSION The association between GORD and a range of diseases was extensively studied, and our findings revealed a high certainty of evidence of the association between GORD and an increased risk of COPD exacerbation as well as increased prevalence of oesophageal adenocarcinoma. Further investigations using systematic reviews and meta-analyses of high methodological quality that include prospective large cohort studies and adjusted confounders are warranted. PROSPERO REGISTRATION NUMBER CRD42019122264.
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Affiliation(s)
- JinJing Tan
- Graduate School, Jiang Xi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
- Department of Administration, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Liqun Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Xiaoyan Huang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Chengning Yang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Xue Liang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Yina Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Jieru Xie
- Department of Center of Preventive Disease Treatment, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Ran Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Daogang Wang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Sheng Xie
- Department of Administration, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
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Parsel SM, Iarocci AL, Gastañaduy M, Winters RD, Marino JP, McCoul ED. Response to “The Association Between Reflux and Laryngeal Neoplasia Is Still Not Demonstrated”. Otolaryngol Head Neck Surg 2020; 163:1285-1286. [DOI: 10.1177/0194599820938320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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32
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Park JC, Altman KW, Prasad VMN, Broadhurst M, Akst LM. Laryngeal Leukoplakia: State of the Art Review. Otolaryngol Head Neck Surg 2020; 164:1153-1159. [DOI: 10.1177/0194599820965910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective This state-of-the-art article reviews the epidemiology, diagnosis, and management of vocal fold leukoplakia, with focus on recent advances. It focuses on the clinical challenges that otolaryngologists face balancing both oncological efficacy and functional outcomes in leukoplakia and presents the current philosophies and techniques to consider when managing such patients. Data Sources PubMed/MEDLINE. Review Methods We conducted a detailed review of publications related to vocal cord and laryngeal leukoplakia, dysplasia, hyperkeratosis, leukoplakia endoscopy, and leukoplakia management focusing specifically on oncologic outcomes, voice preservation, current and emerging diagnosis, and management techniques. Conclusions There has been a paradigm shift away from performing “vocal cord stripping” procedures that can cause irreversible hoarseness toward voice preservation surgery while achieving comparable oncologic control. Surgical technical and instrumental developments have been designed to maximally treat superficial disease while preserving underling vibratory mucosa. Recent improvements in histopathological grading systems and advances in biomarker classification may allow for improved oncologic risk stratification. Furthermore, improvements in endoscopic imaging capabilities and contact endoscopy are currently being studied for their potential diagnostic significance. Implications for Practice To optimally manage vocal fold leukoplakia, the otolaryngologist should become familiar with the oncologic implications of the disease and the importance of obtaining pathologic diagnosis to rule out malignancy. In addition, the surgeon should maintain surgical techniques and knowledge of available instruments and lasers that can assist in surgical management while prioritizing the preservation of vibratory tissue and voice quality. Finally, the surgeon and the patient should understand the clinical importance of routine endoscopic surveillance.
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Affiliation(s)
- Joseph C. Park
- Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kenneth W. Altman
- Department of Otolaryngology–Head and Neck Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | | | | | - Lee M. Akst
- Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Wu Y, Wang J, Huang Q, Peng T, Zhao L, Feng G, Liu Y. The Relationship Between Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux Based on pH Monitoring. EAR, NOSE & THROAT JOURNAL 2020; 100:249-253. [PMID: 33170043 DOI: 10.1177/0145561320971915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Many studies on the relationship between gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) were based on symptoms, but there are few research on it using reflux monitoring. This study was designed to investigate the relationship between GERD and LPR based on pH monitoring. METHODS All patients were scheduled for esophageal manometry and pH monitoring sequentially. They were stratified into 4 groups as no reflux disease, isolated GERD, isolated LPR (iLPR), and GERD combined with LPR (GERD&LPR) according to pH monitoring. RESULTS The incidence of LPR in GERD was 46.3%, while the probability of combining GERD in LPR was 52.7%. The reflux profile in the laryngopharynx showed a significant difference in the total reflux time (17.82 ± 18.4 vs 9.62 ± 9.58, P = .023) and the percentage of total reflux time (1.31% ± 1.37% vs 0.71% ± .0.73%, P = .023) between the GERD&LPR and iLPR groups. CONCLUSION Laryngopharyngeal reflux can be combined with GERD or it can exist as an independent diagnosis. In patients with GERD&LPR, the total reflux time and the percentage of reflux time in the laryngopharynx are higher than those in the iLPR group. Reflux episodes in the laryngopharynx of patients with GERD&LPR may be derived from GERD.
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Affiliation(s)
- Yun Wu
- Department of Gastroenterology, 71185Peking University People's Hospital, Beijing, China
| | - Junyao Wang
- Department of Gastroenterology, 71185Peking University People's Hospital, Beijing, China
| | - Qing Huang
- Department of Gastroenterology, 71185Peking University People's Hospital, Beijing, China
| | - Tao Peng
- Department of Gastroenterology, 71185Peking University People's Hospital, Beijing, China
| | - Lili Zhao
- Department of Gastroenterology, 71185Peking University People's Hospital, Beijing, China
| | - Guijian Feng
- Department of Gastroenterology, 71185Peking University People's Hospital, Beijing, China
| | - Yulan Liu
- Department of Gastroenterology, 71185Peking University People's Hospital, Beijing, China
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Eells AC, Mackintosh C, Marks L, Marino MJ. Gastroesophageal reflux disease and head and neck cancers: A systematic review and meta-analysis. Am J Otolaryngol 2020; 41:102653. [PMID: 32841763 DOI: 10.1016/j.amjoto.2020.102653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/02/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Gastroesophageal reflux disease (GERD) has been associated with head and neck cancer (HNC), including laryngeal and pharyngeal anatomical sites. A systematic review and meta-analysis was performed to examine these associations. METHODS Articles were retrieved from the Medline, Web of Science, Scopus, and Embase databases using keywords "gastroesophageal reflux disease", "laryngopharyngeal reflux", "head and neck cancer", and associated variants. Inclusion criteria were English language publications, human subjects, and controlled studies with described development of head and neck cancer among individuals with GERD. 13 studies with a total of 39,824 patients were included. RESULTS Overall, presence of GERD was associated with an increased risk of developing HNC (OR = 1.86, 95% Confidence Interval [CI] = 1.27-2.74). This association remained significant with laryngeal cancers (OR = 1.95, 95% CI = 1.33-2.86), but not pharyngeal cancers (OR = 1.56, 95% CI = 0.86-2.83). Subgroup analyses of hypopharyngeal (OR = 2.26, 95% CI = 0.67-7.68) and oropharyngeal subsites (OR = 1.39, 95% CI = 0.51-3.84) were not statistically significant. Meta-analysis of studies that objectively assessed reflux, such as pH monitor placement, showed statistical significance (OR = 2.81, 95% CI = 1.36-5.81), while studies that used subjective reporting or chart review of GERD were not significant (OR = 1.46, 95% CI = 0.89-2.40). Association between H. pylori infection and head and neck cancers was not statistically significant (OR = 2.66, 95% CI = 0.59-11.97). CONCLUSION A diagnosis of GERD is associated with a later diagnosis of HNC, but this association is not significant for pharyngeal cancers. Associations of GERD with HNC may be specific to laryngeal cancers. LEVEL OF EVIDENCE Systematic review and meta-analysis of case control studies (3a).
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Laryngeal and Pharyngeal Squamous Cell Carcinoma After Antireflux Surgery in the 5 Nordic Countries. Ann Surg 2020; 276:e79-e85. [DOI: 10.1097/sla.0000000000004423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Antireflux surgery and risk of lung cancer by histological type in a multinational cohort study. Eur J Cancer 2020; 138:80-88. [PMID: 32877797 DOI: 10.1016/j.ejca.2020.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/04/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Airway micro-aspiration might contribute to the proposed associations between gastroesophageal reflux disease (GERD) and some lung diseases, including lung cancer. This study aimed to examine the hypothesis that antireflux surgery decreases the risk of small cell carcinoma, squamous cell carcinoma and adenocarcinoma of the lung differently depending on their location in relation to micro-aspiration. METHODS Population-based cohort study including patients having undergone antireflux surgery during 1980-2014 in Denmark, Finland, Iceland, Norway or Sweden. Patients having undergone antireflux surgery were compared with two groups: 1) the corresponding background population, by calculating standardised incidence ratios (SIRs) with 95% confidence intervals (CIs) and 2) non-operated GERD-patients, by calculating hazard ratios (HRs) with 95% CIs using multivariable Cox regression with adjustment for sex, age, calendar period, country, chronic obstructive pulmonary disease and obesity diagnosis or type 2 diabetes. RESULTS Among all 812,617 GERD-patients, 46,996 (5.8%) had undergone antireflux surgery. The SIRs were statistically significantly decreased for small cell carcinoma (SIR = 0.57, 95% CI 0.41-0.77) and squamous cell carcinoma (SIR = 0.75, 95% CI 0.60-0.92), but not for adenocarcinoma of the lung (SIR = 0.90, 95% CI 0.76-1.06). The HRs were also below unity for small cell carcinoma (HR = 0.63, 95% CI 0.44-0.90) and squamous cell carcinoma (HR = 0.80, 95% CI 0.62-1.03), but not for adenocarcinoma of the lung (HR = 1.03, 95% CI 0.84-1.26). Analyses restricted to patients with objective GERD (reflux oesophagitis or Barrett's oesophagus) showed similar results. CONCLUSIONS This all-Nordic study indicates that patients who undergo antireflux surgery are at decreased risk of small cell carcinoma and squamous cell carcinoma of the lung, but not of adenocarcinoma of the lung.
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Vageli DP, Kasle D, Doukas SG, Doukas PG, Sasaki CT. The temporal effects of topical NF- κB inhibition, in the in vivo prevention of bile-related oncogenic mRNA and miRNA phenotypes in murine hypopharyngeal mucosa: a preclinical model. Oncotarget 2020; 11:3303-3314. [PMID: 32934775 PMCID: PMC7476734 DOI: 10.18632/oncotarget.27706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022] Open
Abstract
Supraesophageal bile reflux at strongly acidic pH can cause hypopharyngeal squamous cell cancer, through activation of the oncogenic NF-κB-related pathway. We hypothesize that topical pre- or post-application of pharmacologic NF-κB inhibitor, BAY 11-7082 (0.25 μmol), on murine (C57BL/6J) HM (twice a day for 10 days) can effectively inhibit acidic bile (10 mmol/l; pH 3.0) induced oncogenic molecular events, similar to prior in vitro findings. We demonstrate that the administration of BAY 11-7082, either before or after acidic bile, eliminates NF-κB activation, prevents overexpression of Bcl2, Rela, Stat3, Egfr, Tnf, Wnt5a, and deregulations of miR-192, miR-504, linked to bile reflux-related hypopharyngeal cancer. Pre- but not post-application of NF-κB inhibitor, significantly blocks overexpression of Il6 and prostaglandin H synthases 2 (Ptgs2), and reverses miR-21, miR-155, miR-99a phenotypes, supporting its early bile-induced pro-inflammatory effect. We thus provide novel evidence that topical administration of a pharmacological NF-κB inhibitor, either before or after acidic bile exposure can successfully prevent its oncogenic mRNA and miRNA phenotypes in HM, supporting the observation that co-administration of NF-κB inhibitor may not be essential in preventing early bile-related oncogenic events and encouraging a capacity for further translational exploration.
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Affiliation(s)
- Dimitra P Vageli
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - David Kasle
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Sotirios G Doukas
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Panagiotis G Doukas
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Clarence T Sasaki
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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Han H, Lyu Q, Zhao J. Laryngopharyngeal Reflux in Hypertrophic Laryngeal Diseases. EAR, NOSE & THROAT JOURNAL 2020; 101:NP158-NP163. [PMID: 32865459 DOI: 10.1177/0145561320953232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To evaluate the characteristics of laryngopharyngeal reflux (LPR) in patients with different hypertrophic laryngeal diseases and to explore the relationship between LPR and these diseases. METHODS A retrospective analysis was performed. The clinical data of 154 patients were collected. According to their diagnoses, patients were divided into 3 groups. Group 1 included 49 patients with vocal cord polyps. Group 2 contained 52 patients with vocal cord leukoplakia. Group 3 included 53 patients with laryngeal carcinoma. The reflux symptom indexes (RSIs), reflux finding scores (RFSs), and Ryan scores of all patients were evaluated and compared. RESULTS Patients with vocal cord polyps were the youngest of the 3 groups, and those with laryngeal carcinoma were the oldest. A male preponderance emerged in each group. In total, 128 patients (83.12%) had positive RSI/RFS values and 60 (60/146, 41.1%) patients had positive Ryan scores. The positive RSI/RFS rates of both groups 1 and 2 (89.80% and 92.16%, respectively) were significantly higher than that of group 3 (69.81%). Moreover, the positive Ryan score rates in both groups 1 and 2 (39.58% and 53.85%, respectively) were significantly higher than that of group 3 (28.26%). CONCLUSIONS Laryngopharyngeal reflux occurs in many patients with vocal cord polyps, vocal cord leukoplakia, and vocal cord carcinoma, indicating that LPR may be important in the pathogenesis of these diseases. Laryngopharyngeal reflux occurs more common in patients with vocal cord polyps and leukoplakia and less common in those with laryngeal carcinoma, suggesting the role of LPR on these diseases may be different.
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Affiliation(s)
- Honglei Han
- Department of Otolaryngology-Head and Neck Surgery, 36635China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Qiuping Lyu
- Department of Otolaryngology-Head and Neck Surgery, 36635China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Jianhui Zhao
- Department of Otolaryngology-Head and Neck Surgery, 36635China-Japan Friendship Hospital, Beijing, People's Republic of China
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Choi YS, Na HG, Bae CH, Song SY, Kim YD. Pepsin exposure in a non-acidic environment upregulates mucin 5AC (MUC5AC) expression via matrix metalloproteinase 9 (MMP9)/nuclear factor κB (NF-κB) in human airway epithelial cells. Int Forum Allergy Rhinol 2020; 11:894-901. [PMID: 32846027 DOI: 10.1002/alr.22685] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gastric reflux (GR) is a backflow of gastric content to the aerodigestive tract. GR was previously found to be associated with inflammatory airway diseases and a potential cause of airway remodeling. Chronic exposure to gastric content may induce damage from nose to lung, because digestive enzymes and acidity are toxic to airway epithelial cells. Recently, the toxicity of pepsin in a non-acidic environment was found to increase proinflammatory cytokines and receptors in the epithelium of the aerodigestive tract. However, the effect of pepsin in non-acidic conditions on mucin expression has not been investigated in human airway epithelial cells. The purpose of this study was to evaluate the effect of pepsin on mucin 5AC (MUC5AC) expression in upper and lower airway epithelial cells as an important potential factor of non-acidic GR-related airway inflammation. METHODS In NCI-H292 cells and human nasal epithelial cells (HNEpCs), the effects and signaling pathways of pepsin on MUC5AC expression were examined using reverse-transcription polymerase chain reaction (RT-PCR), real-time PCR, enzyme immunoassay, zymography, Western blot, and immunofluorescence staining. RESULTS Pepsin increased MUC5AC expression in non-acidic condition of NCI-H292 cells and HNEpCs. Further, pepsin activated matrix metalloproteinase 9 (MMP9) and phosphorylated nuclear factor κB (NF-κB). Moreover, inhibitors of MMP9 and NF-κB significantly attenuated pepsin-induced MUC5AC expression, and the knockdown of NF-κB by small interfering RNA (siRNA) significantly blocked pepsin-induced MUC5AC expression in human airway epithelial cells. CONCLUSION These findings suggest that pepsin increased MUC5AC expression in non-acidic conditions via the activation of MMP9 and NF-κB in human airway epithelial cells.
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Affiliation(s)
- Yoon Seok Choi
- Department of Otorhinolaryngology-Head and Neck surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Hyung Gyun Na
- Department of Otorhinolaryngology-Head and Neck surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Chang Hoon Bae
- Department of Otorhinolaryngology-Head and Neck surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Si-Youn Song
- Department of Otorhinolaryngology-Head and Neck surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Yong-Dae Kim
- Department of Otorhinolaryngology-Head and Neck surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea.,Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Republic of Korea
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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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Lechien JR, Akst LM, Saussez S, Crevier-Buchman L, Hans S, Barillari MR, Calvo-Henriquez C, Bock JM, Carroll TL. Involvement of Laryngopharyngeal Reflux in Select Nonfunctional Laryngeal Diseases: A Systematic Review. Otolaryngol Head Neck Surg 2020; 164:37-48. [DOI: 10.1177/0194599820933209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives To investigate the existing published evidence supporting the role of laryngopharyngeal reflux (LPR) in the development of the select nonfunctional laryngeal diseases of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections Data Sources PubMed, Cochrane Library, and Scopus. Review Methods A systematic review was performed by 3 independent investigators for studies providing information about the prevalence and role of LPR in the development of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections. Diagnostic criteria and clinical outcome evaluation of included studies were analyzed with PRISMA criteria. Results Of the 64 relevant publications, 27 clinical and 4 basic science studies were included. Ten studies used objective reliable examinations for LPR diagnosis (eg, dual- or triple-probe or oropharyngeal pH monitoring, multichannel intraluminal impedance–pH monitoring, or pepsin detection). According to the bias analysis and the results of studies, the association between LPR and laryngotracheal stenosis, leukoplakia, laryngeal papillomatosis, or vocal fold granuloma remains poorly demonstrated. There is a notable heterogeneity among included studies regarding their inclusion criteria, diagnostic methods, and clinical outcome evaluation. Although some experimental findings support the involvement of bile salts and other gastroduodenal proteins active in alkaline pH, no included clinical studies assessed the role of nonacid and mixed reflux through multichannel intraluminal impedance–pH monitoring. Conclusion The involvement of LPR in the development of leukoplakia, laryngotracheal stenosis, vocal fold granuloma, and laryngeal papillomatosis is currently not demonstrated. The potential relationship between LPR and these select nonfunctional laryngeal diseases must be confirmed through future clinical and experimental studies considering acid, nonacid, and mixed LPR.
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Affiliation(s)
- Jerome R. Lechien
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lee M. Akst
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lise Crevier-Buchman
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Stéphane Hans
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy
| | - Christian Calvo-Henriquez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jonathan M. Bock
- Division of Laryngology and the Professional Voice Department of Otolaryngology and Communication Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas L. Carroll
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Fischer JL, Riley CA, Hsieh MC, Marino MJ, Wu XC, McCoul ED. Prevalence of Eustachian Tube Dysfunction in the US Elderly Population. Otolaryngol Head Neck Surg 2020; 163:1169-1177. [DOI: 10.1177/0194599820932541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective To investigate the prevalence of eustachian tube dysfunction (ETD) in elderly adults in the United States and its association with other upper aerodigestive inflammatory processes. Study Design Cross-sectional study. Setting Population based. Subjects and Methods In total, 147,805 patients without malignancy were compared to 13,804 demographically matched patients with malignancy of the upper aerodigestive tract (UADT) by querying the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database for patients aged 66 to 99 years between 2003 and 2011. The prevalence of ETD and inflammatory diseases among these patients was compared. Association between ETD, other upper aerodigestive inflammatory processes, and UADT malignancies was evaluated. Results The prevalence of ETD was 5.44% among patients without malignancy and 9.08% in those with cancer (odds ratio [OR], 1.73; 95% CI, 1.63-1.84). Patients with ETD in the control population were more likely (OR, 95% CI) to be diagnosed with chronic rhinitis (5.00, 4.70-5.33), chronic sinusitis (4.20, 3.98-4.43), allergic rhinitis (4.27, 4.08-4.47), and gastroesophageal reflux disease (GERD) (2.42, 2.31-2.53). Patients with ETD and chronic rhinitis (1.43, 1.24-1.65), chronic sinusitis (1.57, 1.38-1.78), and acute otitis media (1.33, 1.08-1.65) were associated with higher rates of UADT malignancy. Conclusion Over 5% of patients older than 65 in the United States are diagnosed with ETD in the absence of UADT malignancy. Associations between ETD and chronic rhinitis, chronic sinusitis, allergic rhinitis, and GERD in the absence of UADT malignancy suggest that some patients may benefit from treatment of inflammatory disease as a cause of ETD.
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Affiliation(s)
- Jakob L. Fischer
- Department of Otolaryngology–Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Charles A. Riley
- Division of Otolaryngology–Head and Neck Surgery, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry/Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Michael J. Marino
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Foundation, Phoenix, Arizona, USA
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry/Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Edward D. McCoul
- Department of Otolaryngology–Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
- Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, Louisiana, USA
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Xiao S, Li J, Zheng H, Yan Y, Li X, Zhang L, Lv Q, Zhang J, Zeng L, Gao X, Chen X, Yang H, Zhao C, Zhang J, Lu H, Luo X, Wang G, Yi H, Ye J, Lin Z, Tian L, Zhang J, Chen T, Yu A, Liu Z, Ren X, Yang X, Zhang S, Cui X, Li G, Wan G, Lin C, Chen H, Deng A, Tang X, Zhang Q, Tao Z, Shi L, Zhou J, Qin G, Zhuang P, Huangfu H, Yang J, Zhou G, Li H, Wu W, Li J, Li S, Lou G, Fang H, Ma J, Shan C, Zhou X, Tang L, Zhou F, Fan Y, Zhang Y, Li Y, Li M, Dou C, Chen Z, Lei G, Li J, Gao Z, Huang Y, Ma X, Liu Z, Liang G, He J, Zhao H, Song B, Chen M, Yang X, Ma Z, Ren J. An epidemiological survey of laryngopharyngeal reflux disease at the otorhinolaryngology-head and neck surgery clinics in China. Eur Arch Otorhinolaryngol 2020; 277:2829-2838. [PMID: 32449029 DOI: 10.1007/s00405-020-06045-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/09/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Using the Reflux Symptom Index (RSI), this nationwide study aimed to investigate the incidence, diagnostic status, risk factors, and common symptoms of adult laryngopharyngeal reflux disease (LPRD) at otorhinolaryngology-head and neck surgery (OHNS) clinics in China. METHODS This multicenter cross-sectional survey began at the different institutions ranged from July to October 2017, and the duration was 12 months. A total of 90,440 eligible patients were finally enrolled from 72 medical institutions in China. All these patients completed the questionnaire based on RSI. In this study, LPRD was defined as RSI > 13. RESULTS There were 9182 with LPRD among the 90,440 eligible participants (10.15%). However, only 1294 had a history of LPRD diagnosis among those with LPRD (14.09%). There were regional differences in the frequency of LPRD (P < 0.001). The proportions of patients with LPRD in males (vs. females), middle- and old-aged patients (vs. young), with current smoking history (vs. no smoking), and current drinking history (vs. no drinking) were significantly higher (all P < 0.001). Middle and old age, current smoking, and drinking history were independent predictors of LPRD (all P < 0.001, OR 1.240, 1.261, and 1.481, respectively). "Sensations of something stuck in throat or a lump in throat", "clearing throat", and "excess throat mucus or postnasal drip" were the most frequent clinical symptoms in patients with LPRD. CONCLUSIONS LPRD has a high incidence at the OHNS clinics in China. However, the diagnostic status of this disease is not optimistic. Older age, smoking, and drinking history were risk factors for LPRD.
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Affiliation(s)
- Shuifang Xiao
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University First Hospital, 8# Xishiku Street, Western District, Beijing, 100034, China.
| | - Jinrang Li
- Department of Otorhinolaryngology, Head and Neck Surgery, The Sixth Medical Center of Chinese PLA General Hospital, 6# Fucheng Road, Haidian District, Beijing, 100048, China.
| | - Hongliang Zheng
- Department of Otorhinolaryngology, Head and Neck Surgery, Changhai Hospital, Second Military Medical University, 168# Changhai Street, Yangpu District, Shanghai, 200433, China.
| | - Yan Yan
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University Third Hospital, Beijing, China
| | - Xiangping Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Lihong Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Quiping Lv
- Department of Otorhinolaryngology, Head and Neck Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Junbo Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University First Hospital, 8# Xishiku Street, Western District, Beijing, 100034, China
| | - Lin Zeng
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Xia Gao
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiong Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- Department of Otorhinolaryngology, Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hui Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Chen Zhao
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jian Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Honghua Lu
- Department of Otorhinolaryngology, Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Xianyang Luo
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Guangke Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Hongliang Yi
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, Shanghai, China
| | - Jin Ye
- Department of Otorhinolaryngology, Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhenqun Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, Hainan Provincial People's Hospital, Hiakou, Hainan, China
| | - Linli Tian
- Department of Otorhinolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jingjing Zhang
- Department of Otorhinolaryngology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Ting Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Aimin Yu
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Medical School, Yangzhou University, Yangzhou, Jiangsu, China
| | - Zhaohui Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Xiaoyong Ren
- Department of Otorhinolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xinming Yang
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Siyi Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Xiaobo Cui
- Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Gelin Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guanglun Wan
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Chang Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Hui Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Anchun Deng
- Department of Otorhinolaryngology, Head and Neck Surgery, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Xiabing Tang
- Department of Otorhinolaryngology, Head and Neck Surgery, Wuxi People's Hospital, Wuxi, Jiangsu, China
| | - Qingfeng Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Dalian Central Hospital, Dalian, Liaoning, China
- Department of Otorhinolaryngology, Head and Neck Surgery, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Zhenfeng Tao
- Department of Otorhinolaryngology, Head and Neck Surgery, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Li Shi
- Department of Otorhinolaryngology, Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Jianyong Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Jiangmen Central Hospital, Jiangmen, Guangdong, China
| | - Gang Qin
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Peiyun Zhuang
- Department of Voice, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Hui Huangfu
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jianming Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Guojin Zhou
- Department of Otorhinolaryngology, Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Huijun Li
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Wei Wu
- Department of Otorhinolaryngology, Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center, Beijing, China
| | - Julan Li
- Department of Otorhinolaryngology Head and Neck Surgery, Sichuan Provincial Corps Hospital, Chinese People's Armed Police Force, Leshan, Sichuan, China
| | - Shuhua Li
- Department of Otorhinolaryngology Head and Neck Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Guangming Lou
- Department of Otorhinolaryngology Head and Neck Surgery, The First Hospital of Longyan City, Longyan, Fujian, China
| | - Hongyan Fang
- Department of Otorhinolaryngology Head and Neck Surgery, Chongqing General Hospital, Chongqing, China
| | - Jiangang Ma
- Department of Otorhinolaryngology, Head and Neck Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chunguang Shan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xuejun Zhou
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Hainan Medical College, Haikou, Hainan, China
| | - Liang Tang
- Department of Otorhinolaryngology, Head and Neck Surgery, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Fang Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Changsha Central Hospital, Changsha, Hunan, China
| | - Yunping Fan
- Department of Otorhinolaryngology Head and Neck Surgery, The Fifth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanping Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The 8th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yujie Li
- Department of Otorhinolaryngology Head and Neck Surgery, Zhengzhou Central Hospital, Zhengzhou, Henan, China
| | - Meisheng Li
- Department of Otorhinolaryngology Head and Neck Surgery, The First People's Hospital of Shangqiu City, Shangqiu, Henan, China
| | - Chunqiang Dou
- Department of Otorhinolaryngology, Head and Neck Surgery, Linfen People's Hospital, Linfen, Shanxi, China
| | - Zhiling Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Gang Lei
- Department of Otorhinolaryngology Head and Neck Surgery, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Jingbo Li
- Department of Otorhinolaryngology Head and Neck Surgery, Henan Provincial Hospital of Traditional Chinese Medicine, Zhengzhou, Henan, China
| | - Zhiguang Gao
- Department of Otorhinolaryngology Head and Neck Surgery, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
| | - Yongwang Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xinchun Ma
- Department of Otorhinolaryngology, Head and Neck Surgery, The Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Zhijun Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Chizhou People's Hospital, Chizhou, Anhui, China
| | - Gengtian Liang
- Department of Otorhinolaryngology, Head and Neck Surgery, Wuhan Third Hospital, Wuhan, Hubei, China
| | - Jian He
- Department of Otorhinolaryngology, Head and Neck Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Hua Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, Xinjiang Military Command General Hospital, Urumqi, Xinjiang, China
| | - Bailong Song
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Hospital of Chifeng College, Chifeng, Inner Mongolia, China
| | - Meijun Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The People's Hospital of Dazu District, Chongqing, China
| | - Xiangli Yang
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Zuopeng Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Qinghai Red Cross Hospital, Xining, Qinghai, China
| | - Jinlong Ren
- Department of Otorhinolaryngology, Head and Neck Surgery, Fenyang Hospital, Shanxi Province, Fenyang, Shanxi, China
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Parsel SM, Iarocci AL, Gastañaduy M, Winters RD, Marino JP, McCoul ED. Reflux Disease and Laryngeal Neoplasia in Nonsmokers and Nondrinkers. Otolaryngol Head Neck Surg 2020; 163:560-562. [PMID: 32340545 DOI: 10.1177/0194599820917669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gastroesophageal reflux disease (GERD) has been hypothesized as a risk factor for development of laryngeal cancer. A case-control study was performed to assess the association of laryngeal neoplasia with GERD. Cases consisted of patients with a history of laryngeal cancer or carcinoma in situ. Controls were patients without neoplasia who matched cases 2:1 on age, sex, race, and smoking history. Univariate and multivariate analyses were performed to assess risk of laryngeal neoplasia and GERD. In total, 2094 patients were included. Cases had higher rates of GERD. Univariate analysis demonstrated a positive association between GERD and laryngeal neoplasia (odds ratio, 1.33; 95% CI, 1.07-1.64). Multivariate analysis controlling for alcohol use history also demonstrated a positive association between GERD and laryngeal neoplasia (adjusted odds ratio, 1.29; 95% CI, 1.04-1.59). These results suggest increased odds of laryngeal carcinoma and carcinoma in situ in patients with GERD when controlling for smoking and drinking history.
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Affiliation(s)
- Sean M Parsel
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Andrew L Iarocci
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA
| | - Mariella Gastañaduy
- Ochsner Health System, Center for Outcomes and Health Services Research, New Orleans, Louisiana, USA
| | - Ryan D Winters
- Department of Otorhinolaryngology, Ochsner Health System, New Orleans, Louisiana, USA
| | - Jeffrey P Marino
- Department of Otorhinolaryngology, Ochsner Health System, New Orleans, Louisiana, USA
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, Louisiana, USA.,Ochsner Health System, Center for Outcomes and Health Services Research, New Orleans, Louisiana, USA.,Ochsner Clinical School, University of Queensland, New Orleans, Louisiana, USA
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45
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McCormick CA, Samuels TL, Battle MA, Frolkis T, Blumin JH, Bock JM, Wells C, Yan K, Altman KW, Johnston N. H+/K+ATPase Expression in the Larynx of Laryngopharyngeal Reflux and Laryngeal Cancer Patients. Laryngoscope 2020; 131:130-135. [PMID: 32250454 DOI: 10.1002/lary.28643] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The gastric H+/K+ ATPase proton pump has previously been shown to be expressed in the human larynx, however its contribution to laryngopharyngeal reflux (LPR) signs, symptoms and associated diseases such as laryngeal cancer is unknown. Proton pump expression in the larynx of patients with LPR and laryngeal cancer was investigated herein. A human hypopharyngeal cell line expressing the proton pump was generated to investigate its effects. STUDY DESIGN In-vitro translational. METHODS Laryngeal biopsies were obtained from three LPR and eight LSCC patients. ATP4A, ATP4B and HRPT1 were assayed via qPCR. Human hypopharyngeal FaDu cell lines stably expressing proton pump were created using lentiviral transduction and examined via transmission electron microscopy and qPCR for genes associated with inflammation or laryngeal cancer. RESULTS Expression of ATP4A and ATP4B was detected in 3/3 LPR, 4/8 LSCC-tumor and 3/8 LSCC-adjacent specimens. Expression of ATP4A and ATP4B in FaDu elicited mitochondrial damage and expression of IL1B, PTGS2, and TNFA (P < .0001); expression of ATP4B alone did not. CONCLUSIONS Gastric proton pump subunits are expressed in the larynx of LPR and LSCC patients. Mitochondrial damage and changes in gene expression observed in cells expressing the full proton pump, absent in those expressing a single subunit, suggest that acid secretion by functional proton pumps expressed in upper airway mucosa may elicit local cell and molecular changes associated with inflammation and cancer. LEVEL OF EVIDENCE NA Laryngoscope, 131:130-135, 2021.
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Affiliation(s)
- Caroline A McCormick
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Tina L Samuels
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Michele A Battle
- Department of Cell Biology, Neurobiology, & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Talia Frolkis
- Department of Cell Biology, Neurobiology, & Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Joel H Blumin
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jonathan M Bock
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Clive Wells
- Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Ke Yan
- Department of Pediatrics Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Kenneth W Altman
- Department of Otolaryngology, Geisinger Health System, Danville, California, U.S.A
| | - Nikki Johnston
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
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46
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Sasaki CT, Hajek M, Doukas SG, Vageli DP. The role of bile reflux and its related NF-κB activated pathway in progression of hypopharyngeal squamous cell cancer. Oral Oncol 2020; 105:104668. [PMID: 32247988 DOI: 10.1016/j.oraloncology.2020.104668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/10/2020] [Accepted: 03/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prognosis for hypopharyngeal cancer is usually poor, and recurrence is common. Identifying new factors or related mechanisms that promote its progression may have clinical implications. Although, recent studies support bile reflux in hypopharyngeal carcinogenesis, it remains to be explored how bile and its related NF-κB activated pathway may further affects its progression in already established hypopharyngeal cancer. METHODS Hypopharyngeal squamous cell carcinoma (HSCC) cell lines, FaDu and UMSCC11A, both negative for HPV, were repetitively exposed to bile acids (400 μM) at variable pH points (4.0, 5.5 and 7.0). Immunofluorescence, western blotting, luciferase assay, and qPCR were used to detect NF-κB activation, bcl-2 overexpression and gene expression. RESULTS Bile at strongly acidic pH (4.0) potentiated the activation of NF-κB and its related mRNA phenotype in HSCC cells. IL-6, TNF-α, and BCL2 were found among the highest overexpressed genes as was previously found in HSCCs excised from patients with documented biliary reflux. An enhanced transcriptional activity of EGFR, RELA, STAT3, and WNT5Α and higher survival rates were observed in HSCC cells exposed to acidic bile compared to those exposed to bile at weakly acidic or neutral pH. CONCLUSION Our novel findings support the observation that bile reflux has the potential for actively influencing the progression of hypopharyngeal cancer, mediated by NF-κB. In patients with hypopharyngeal cancer and known gastroesophageal reflux disease, antacid therapy may exert a role in furthering control of disease recurrence and progression.
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Affiliation(s)
- Clarence T Sasaki
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Michael Hajek
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Sotirios G Doukas
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Dimitra P Vageli
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
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47
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Barrett CM, Patel D, Vaezi MF. Laryngopharyngeal Reflux and Atypical Gastroesophageal Reflux Disease. Gastrointest Endosc Clin N Am 2020; 30:361-376. [PMID: 32146951 DOI: 10.1016/j.giec.2019.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Laryngopharyngeal reflux and atypical manifestations of gastroesophageal reflux disease have a high economic and social burden in the United States. There is increasing research supporting the reflex theory and hypersensitivity syndrome underlying this disease pathophysiology. Novel diagnostic biomarkers have gained more traction in the search for a more reliable diagnostic tool, but further research is needed. Current standard-of-care treatment relies on proton pump inhibitor therapy. Antireflux surgery is usually not recommended. Neuromodulators and treatments targeting specific neuronal receptors are discussed. A diagnostic algorithm is proposed for the evaluation of laryngeal symptoms suspected to be related to extraesophageal reflux disease.
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Affiliation(s)
- Caroline M Barrett
- Department of Internal Medicine, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 20400, Nashville, TN 37204, USA
| | - Dhyanesh Patel
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, 1301 Medical Center Drive, TVC # 1660, Nashville, TN 37232, USA.
| | - Michael F Vaezi
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, 1301 Medical Center Drive, TVC # 1660, Nashville, TN 37232, USA
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48
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Li S, Huang M, Wu G, Huang W, Huang Z, Yang X, Ou J, Wei Q, Liu C, Yu S. Efficacy of Chinese Herbal Formula Sini Zuojin Decoction in Treating Gastroesophageal Reflux Disease: Clinical Evidence and Potential Mechanisms. Front Pharmacol 2020; 11:76. [PMID: 32174826 PMCID: PMC7057234 DOI: 10.3389/fphar.2020.00076] [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: 02/25/2019] [Accepted: 01/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background Based on 122 cases reported in China, data mining indicated that Sini Powder (SNP) and the Zuojin Pill (ZJP) are both widely used as the basic recipe for treating Gastroesophageal Reflux Disease (GERD). Objectives To evaluate the intervention effects of Sini Zuojin Decoction (SNZJD) in patients with GERD. Methods A comprehensive collection of randomized controlled trials (RCTs) using SNZJD in patients with GERD that were published in domestic and foreign journals was made by computer retrieval. RevMan 5.3 software was used for meta-analysis and bias risk assessment, Stata 14.0 software was used for sensitivity analysis, GRADE profiler 3.6 was used to evaluate the level of evidence, and trial sequential analysis (TSA), employed to control for random errors, was performed to assess the main outcomes. Network pharmacology analysis was applied to preliminarily study the mechanisms of action of SNZJD on GERD. Results Thirteen articles were eventually included, covering a total of 966 patients. Meta-analysis indicated that: ① the SNZJD plus traditional stomach medicines (SPTSM) group was more effective than the traditional stomach medicines (TSM) group (RR = 1.16, 95% CI [1.04, 1.29], P = 0.009); ② the experimental group with SNZJD was significantly better than TSM controls in improving heartburn, substernal chest pain, acid regurgitation, and food regurgitation symptoms (P < 0.0001); ③ SPTSM could significantly decrease total symptom scores with substantial effectiveness (P < 0.00001). The recurrence rate and adverse effects of SNZJD treatment were significantly reduced (P < 0.05). TSA showed that the effective rate of meta-analysis might be reliable, but the recurrence and safety results were still uncertain. According to the evaluation by the GRADE method, the quality of evidence was low. Besides, SNZJD might treat GERD by acting on related targets and pathways such as inflammation, hormone regulation, and so on. Conclusions SNZJD might be useful in the treatment of GERD, but its long-term effects and specific clinical mechanisms are unclear. Due to the poor quality of the evidence, more samples and high-quality clinical studies should be tested and verified in the future.
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Affiliation(s)
- Shaowei Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mengfen Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guojing Wu
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Otolaryngology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Weihan Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhanhui Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoqian Yang
- Department of Endodontics, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Jinming Ou
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qipeng Wei
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chengli Liu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaoyuan Yu
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Gastroenterology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
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49
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Sasaki CT, Doukas SG, Costa J, Vageli DP. Biliary reflux as a causal factor in hypopharyngeal carcinoma: New clinical evidence and implications. Cancer 2019; 125:3554-3565. [PMID: 31310330 DOI: 10.1002/cncr.32369] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/16/2019] [Accepted: 06/06/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent preclinical explorations strongly support the tumorigenic potential of bile on laryngopharyngeal mucosa. Herein, the authors describe, in bile-related human hypopharyngeal squamous cell carcinoma (HSCC), NF-κB-related messenger RNA (mRNA) and microRNA (miRNA) oncogenic phenotypes similar to those previously identified in acidic bile-exposed premalignant murine hypopharyngeal mucosa. METHODS In this pilot study, the authors included human HSCC specimens paired with their adjacent normal tissue (ANT) derived from 3 representative patients with documented biliary laryngopharyngeal reflux (bile[+]) compared with 5 control patients without signs of bile reflux disease (bile[-]). Immunohistochemical, quantitative polymerase chain reaction, and miRNA analyses were used to detect the levels of activated NF-κB and expression levels of STAT3, EGFR, BCL2, WNT5A, IL-6, IL-1B, ΔNp63, cREL, TNF-α, TP53, NOTCH1, NOTCH2, NOTCH3, miR-21, miR-155, miR-192, miR-34a, miR-375, miR-451a, miR-489, miR-504, and miR-99a. RESULTS Bile(+) HSCC demonstrated an intense NF-κB activation accompanied by significant overexpression of RELA(p65), EGFR, STAT3, BCL-2, cREL, ΔNp63, WNT5A, IL-6, and IL1B; upregulation of oncomir miR-21; and downregulation of tumor suppressor miR-375 compared with their respective ANTs. Bile(+) HSCC demonstrated significantly higher mRNA levels of all the analyzed genes, particularly RELA(p65), IL-6, EGFR, and TNF-α compared with bile(-) tumors. The miR-21/miR-375 ratio, which previously has been linked to tumor aggressiveness, was found to be >260-fold and >30-fold higher, respectively, in bile(+) HSCCs compared with their ANTs and bile(-) tumors. CONCLUSIONS Although limitations apply to this pilot study due to the small number of patients with HSCC, the novel findings suggest that a history of bile as a component of esophageal reflux disease may represent an independent risk factor for hypopharyngeal carcinogenesis.
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Affiliation(s)
- Clarence T Sasaki
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Sotirios G Doukas
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jose Costa
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Dimitra P Vageli
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Doukas SG, Cardoso B, Tower JI, Vageli DP, Sasaki CT. Biliary tumorigenic effect on hypopharyngeal cells is significantly enhanced by pH reduction. Cancer Med 2019; 8:4417-4427. [PMID: 31173474 PMCID: PMC6675744 DOI: 10.1002/cam4.2194] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/04/2019] [Accepted: 04/11/2019] [Indexed: 12/22/2022] Open
Abstract
Biliary reflux has been considered a potential risk factor in upper aerodigestive tract malignancies. It is not yet clearly known how pH affects the bile-induced activation of NF-κB and its related oncogenic pathway previously linked to hypopharyngeal carcinogenesis. In this study, repetitive applications of conjugated primary bile acids with unconjugated secondary bile acid, deoxycholic acid (DCA), on human hypopharyngeal primary cells reveal that strongly acidic pH (4.0) optimally enhances the tumorigenic effect of bile, by inducing activation of NF-κB, STAT3 nuclear translocation, bcl-2 overexpression and significant overexpression of the oncogenic mRNA phenotype, compared to weakly acidic pH (5.5) or neutral pH (7.0). As the pH becomes less acidic the partially activated primary bile acids and activated DCA begin to exert their influence; however, with significantly less intensity compared to bile acids at strongly acidic pH. Our findings suggest that biliary tumorigenic effect is strongly pH dependent. Controlling pH during reflux events may be therapeutically effective in reducing the potential risk of bile-induced hypopharyngeal cancer.
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Affiliation(s)
- Sotirios G Doukas
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bruno Cardoso
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jacob I Tower
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dimitra P Vageli
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Clarence T Sasaki
- The Yale Larynx Laboratory, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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