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Żurek M, Czesak M, Czerwińska ME, Berezovska D, Niemczyk K, Rzepakowska A. A double-blind randomized clinical trial of inflammatory cytokine and pepsin levels in the saliva of patients with voice prostheses. Head Neck 2024. [PMID: 38864228 DOI: 10.1002/hed.27847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/25/2024] [Accepted: 06/06/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Tracheoesophageal speech is one of the most effective method used for voice rehabilitation after laryngectomy. The main limitation is the need for periodic voice prothesis (VP) replacements. The process of developing VP usage complications is still unexplored. The aim of this study was to assess the level of cytokines (IL-1β, IL-6, IL-8, IL-10, TNFα) and pepsin in saliva as potential factors reducing VP longevity. METHODS Prospective double-blind randomized clinical trial was conducted (NCT04268459). Patients were randomly divided into two groups depending on VP replacement regimen (regular-every 3 months, or irregular-when complications occur). Levels of IL-1β, IL-6, IL-8, IL-10, TNFα, and pepsin in saliva samples (fasting and after eating) of laryngectomized patients were measured using ELISA tests. RESULTS Fifty-two patients (26 in both groups) with control group (7 patients) participated in the study. The level of IL-1β, IL-6, IL-8, IL-10, TNFα, and pepsin did not differ according to regularity of VP replacements (p = 0.301-0.801). IL-6 levels were significantly higher when VP complications occurs (p = 0.012). CONCLUSIONS The saliva components were not significantly different depending on the frequency of VP replacements. IL-6 plays an important role in the development of VP use complications.
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Affiliation(s)
- Michał Żurek
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Czesak
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Monika E Czerwińska
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland
- Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Daria Berezovska
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Warsaw, Poland
- Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Anna Rzepakowska
- Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
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Boyd C, Houghton J, Harrold L, Bond J, Garnett JD, Kraft S. Assessment of Factors Impacting Long-Term Utilization of Tracheoesophageal Speech Among Laryngectomees. Ann Otol Rhinol Laryngol 2020; 130:802-809. [PMID: 33242976 DOI: 10.1177/0003489420976145] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE(S) To evaluate complication rate and abandonment rate after tracheoesophageal puncture and to assess factors associated with these outcome measures. METHODS Retrospective review of laryngectomy patients seen at a single academic institution between 1/1/2003 and 12/1/2018. Charts reviewed for demographics, medical comorbidities, tumor characteristics, surgical data, adjuvant treatment history, and complications related to laryngectomy or tracheoesophageal puncture. Complications were divided into minor and major. RESULTS A total of 293 laryngectomees met inclusion criteria. Of these, 69 patients (23.5%) underwent tracheoesophageal puncture. Average follow up was 64.6 months (SD 58.3). Overall laryngectomy complication rate was 43.3%. Overall tracheoesophageal puncture complication rate was 73.9%, with 39.1% of patients having major complications and 34.8% having minor complications only. Total abandonment rate for tracheoesophageal puncture was 34.8%. No associations were seen between tracheoesophageal puncture complication or abandonment rates based on age, gender, race, or insurance status. An increased rate of laryngectomy complications was seen after primary tracheoesophageal puncture (76.5% vs 41.3%, P = .005). CONCLUSION Tracheoesophageal puncture outcomes were similar in patients with varied demographic, medical, and treatment backgrounds. When considering timing, our findings suggest that patients should be counseled on the possibility of increased complication risk after primary tracheoesophageal puncture. In those in whom the surgeon already has concerns about wound healing, it may be prudent to avoid primary tracheoesophageal puncture. The relatively high abandonment rate emphasizes the value of this measure of tracheoesophageal puncture outcome and highlights the need for appropriate patient counseling and prospective studies assessing the decision to abandon.
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Affiliation(s)
- Christopher Boyd
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - James Houghton
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Logan Harrold
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Justin Bond
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - James D Garnett
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Shannon Kraft
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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Danic Hadzibegovic A, Kozmar A, Hadzibegovic I, Prgomet D, Danic D. Influence of proton pump inhibitor therapy on occurrence of voice prosthesis complications. Eur Arch Otorhinolaryngol 2020; 277:1177-1184. [PMID: 31953634 DOI: 10.1007/s00405-020-05784-4] [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: 09/27/2019] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE It has been shown that the reflux of the gastric content to the proximal oesophagus influences incidence of voice prosthesis (VP) complications in laryngectomized patients. We conducted prospective randomised study to investigate the relationship between pepsin concentration in saliva and occurrence of VP complications before and after 3 months of proton pump inhibitor (PPI) therapy. METHODS 60 laryngectomized patients with VP and 30 controls were included in the study. Saliva samples were collected in the morning and concentration of pepsin were measured by Human Pepsin (PG) ELISA kit. Thirty-Four (57%) patients reported one or more VP complication and were randomised in two groups, with and without PPI therapy, 40 mg pantoprazole per day for 3 months. RESULTS Patients who had longer time since last VP change had higher incidence of periprosthetic and transprosthetic leakage and Candida colonisation. Pepsin was found in all saliva samples. Median saliva pepsin concentration level did not significantly differ between laryngectomized patients and control subjects, or between patients with and without VP complications, and there was no correlation between saliva pepsin concentration levels and type of VP complication. After 3 months therapy, there was no difference in median saliva pepsin level or incidence of VP complication between patients with and without PPI therapy. CONCLUSION Although reflux was proposed to be associated with VP complications and pepsin was proven as a most sensitive and specific marker of EER, we did not find any statistically significant correlation between pepsin levels and occurrence of VP complications. A 3 months 40 mg pantoprazole therapy was ineffective in reduction of VP complications in our study group.
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Affiliation(s)
- Ana Danic Hadzibegovic
- Clinical Department for Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia. .,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia. .,Faculty of Dental Medicine and Health Care, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | - Ana Kozmar
- Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Irzal Hadzibegovic
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health Care, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department for Cardiology, University Hospital Dubrava, Zagreb, Croatia.,Department for Internal Medicine, University Hospital Dubrava, Zagreb, Croatia
| | - Drago Prgomet
- Clinical Department for Otorhinolaryngology and Head and Neck Surgery, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.,School of Medicine, University Zagreb, Zagreb, Croatia
| | - Davorin Danic
- Faculty of Dental Medicine and Health Care, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Gastro-pharyngeal reflux and total laryngectomy. Increasing knowledge about its management. Am J Otolaryngol 2018; 39:127-132. [PMID: 29307652 DOI: 10.1016/j.amjoto.2017.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE Investigate the incidence, the degree and the effect of gastro-pharyngeal reflux (GPR) in laryngectomised patients. MATERIALS AND METHODS Behavioral and 24-hour pH- and impedance-monitoring data were prospectively analyzed for 25 laryngectomised patients with no previous history of GER in outpateints' setting. Reflux detected was characterized as either acid, weakly acidic or nonacid. Proximal reflux was found at 15cm above the LES. RESULTS 40% of patients presented a pathological number of reflux episodes in the upright position (p<0.0001); 9 of them presented a pathologic bolus exposure time. Bolus exposure at the proximal sphincter was one fourth-fold lower than 5cm above the LES (p=0.3593). There was a prevalence of acid reflux at both sphincters (p<0.0001); liquid reflux was prevalent at the LES (p=0.003) and mixed reflux at the UES (p=0.0001). Median REs was higher than time acid exposure (p=0.0013). CONCLUSIONS Pre- and post-surgical reflux investigation could identify preexisting reflux severity and screen potential high-risk cancer patients for postoperative complications. This might allow the early onset of acid suppressive therapy in presence of pathologic findings in high-complication risk cancer patients.
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Coffey MM, Tolley N, Howard D, Drinnan M, Hickson M. An Investigation of the Post-laryngectomy Swallow Using Videofluoroscopy and Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Dysphagia 2018; 33:369-379. [PMID: 29352357 PMCID: PMC5958146 DOI: 10.1007/s00455-017-9862-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/07/2017] [Indexed: 12/14/2022]
Abstract
This study investigates the post-laryngectomy swallow. Presence and degree of residue on the post-laryngectomy swallow as observed on videofluoroscopy and FEES is described. In addition, videofluoroscopy and FEES are assessed for reliability and inter-instrument agreement. 30 laryngectomy subjects underwent dysphagia evaluation using simultaneous videofluoroscopy and FEES. These were reviewed post-examination by three expert raters using a rating scale designed for this purpose. Raters were blinded to subject details, type of laryngectomy surgery, pairing of FEES and videofluoroscopy examinations and the scores of other raters. There was a finding of residue in 78% of videofluoroscopy ratings, and 83% of FEES ratings. Comparison of the tools indicated poor inter-rater reliability and poor inter-instrument agreement. Dysphagia is an issue post laryngectomy as measured by patient self-report and by instrumental evaluation. However, alternative dysphagia rating tools and dysphagia evaluation tools are required to enable accurate identification and intervention for underlying swallow physiology post laryngectomy.
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Affiliation(s)
- Margaret M Coffey
- Imperial College Healthcare Trust, SLT Department, Charing Cross Hospital, Ground Floor, South Wing, Fulham Palace Road, London, W6 8RF, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Neil Tolley
- Imperial College Healthcare Trust, ENT Department, St Mary's Hospital, Praed Street, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Howard
- Imperial College Healthcare Trust, ENT Department, Charing Cross Hospital, Fulham Palace Road, London, W6 8QX, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Michael Drinnan
- Regional Medical Physics Dept, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN, UK
| | - Mary Hickson
- Institute of Health and Community, Plymouth University, Derriford Road, Plymouth, Devon, PL6 8BH, UK
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Thylur DS, Villegas BC, Fisher LM, Sinha UK, Kokot N. Device Life of Two Generations of Provox Voice Prostheses. Ann Otol Rhinol Laryngol 2016; 125:501-7. [DOI: 10.1177/0003489415624701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Tracheoesophageal voice prostheses are invaluable for speech rehabilitation in patients who have received total laryngectomy, but device failure impedes communication and creates psychosocial and financial burdens. This study compares the Provox 2 and Provox Vega voice prostheses on the parameter of device life. Methods: This was a retrospective observational study of 21 patients with 181 device replacements at an academic tertiary care medical center. Disparity in device life and factors that may influence device life were analyzed. Results: The mean device life for Provox 2, at 115.6 days (SE = 5.8), was longer than for Provox Vega, at 65.1 days (SE = 7.5) ( P < .001). Conclusions: Device longevity was greater for Provox 2 over Provox Vega. These results will facilitate the design of prospective studies to assess reasons for variations in device life between patients and device types.
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Affiliation(s)
- David S. Thylur
- USC Tina and Rick Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Brenda Capobres Villegas
- USC Tina and Rick Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Laurel M. Fisher
- USC Tina and Rick Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Uttam K. Sinha
- USC Tina and Rick Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Niels Kokot
- USC Tina and Rick Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Lorenz KJ, Kraft K, Graf F, Pröpper C, Steinestel K. [Importance of cellular tight junction complexes in the development of periprosthetic leakage after prosthetic voice rehabilitation]. HNO 2015; 63:171-2, 174-8, 180-1. [PMID: 25515126 DOI: 10.1007/s00106-014-2951-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The use of voice prostheses is currently the gold standard in voice rehabilitation after total laryngectomy. This method combines low complication rates and excellent rehabilitation results; however, approximately 30% of patients show periprosthetic leakage or severe fistula enlargement after laryngectomy and prosthetic voice restoration within the first 4 years. The development of this enlargement is controversially discussed in the literature but recently published studies have shown that high esophageal reflux plays a key role in this process, which leads to an inflammatory reaction and disturbs the intercellular tight junctions in the sense of an epithelial mesenchymal transition (EMT). MATERIAL AND METHODS A total of 44 patients underwent 24 h pH monitoring, a sample biopsy from the region of the fistula and a subsequent biomolecular examination for intracellular junction proteins as well as a correlation between the severity of reflux and tracheoesophageal fistula problems before and after antireflux therapy with proton pump inhibitors (PPI). RESULTS Immunohistochemical staining revealed decreases in membrane E-cadherin and β-catenin and a significant increase in the cytoplasmic fraction, depending on the severity of inflammation in the fistula tissue. In patients with an improvement of clinical fistula problems under oral PPI treatment an increase of membrane E-cadherin could be shown, whereas patients with persisting fistula enlargement demonstrated a further decrease of E-cadherin. CONCLUSION The data indicate a central role of EMT in the development of fistula enlargement after total laryngectomy. Patients with periprosthetic leakage showed a loss of membrane bound E-cadherin and β-catenin with an up-regulation of vimentin expression. In patients with mild or no leakage problems EMT could be resolved by aggressive antireflux treatment, whereas patients without any effect of PPI treatment on the fistula showed no reversal of EMT. These data contribute to the understanding of treatment resistant fistula enlargement after total laryngectomy.
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Affiliation(s)
- K J Lorenz
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Hals-Chirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland,
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The development and treatment of periprosthetic leakage after prosthetic voice restoration. A literature review and personal experience part I: the development of periprosthetic leakage. Eur Arch Otorhinolaryngol 2014; 272:641-59. [PMID: 25404116 DOI: 10.1007/s00405-014-3394-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/07/2014] [Indexed: 01/04/2023]
Abstract
In the past 30 years, the use of a voice prosthesis has become the treatment of choice for the restoration of speech following laryngectomy. Not only is the placement of a voice prosthesis a simple surgical procedure, but it is also associated with a low rate of complications and an excellent success rate. Approximately, 20-30 % of all patients with voice prostheses, however, develop periprosthetic leakage with aspiration over time. Periprosthetic leakage is usually caused by an enlargement of the tracheo-oesophageal fistula and substantially affects the quality of life of the patients concerned. In a retrospective analysis of our patients, the incidence of periprosthetic leakage was 35.7 % in a total of 232 patients who underwent laryngectomy during a period of 20 years. Substantial enlargement of the tracheo-oesophageal fistula which required multiple treatments occurred in 12.5 % of the patients. In this review, the various causes of fistula enlargement are discussed on the basis of the literature and the experience that we have accumulated during the past 20 years in the management of patients with voice prostheses.
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Lorenz KJ, Kraft K, Graf F, Pröpper C, Steinestel K. Role of reflux-induced epithelial-mesenchymal transition in periprosthetic leakage after prosthetic voice rehabilitation. Head Neck 2014; 37:530-6. [PMID: 24532155 DOI: 10.1002/hed.23622] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 01/10/2014] [Accepted: 02/10/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux (GER) contributes to periprosthetic leakage after prosthetic voice rehabilitation. However, underlying mechanisms are unclear, and markers predicting anti-reflux therapy response are missing. METHODS We assessed epithelial-mesenchymal transition in 148 consecutive biopsies from 44 patients with/without fistula enlargement under dual-probe pH monitoring before and after proton-pump inhibitor (PPI) therapy applying immunohistochemistry. Results were correlated with reflux intensity and clinical and histologic findings. RESULTS Epithelial-mesenchymal transition correlated with GER in all samples, and patients with fistula enlargement showed higher epithelial-mesenchymal transition scores. Contrary to patients without enlargement, epithelial-mesenchymal transition scores did not regress during therapy in this group. Furthermore, pretherapeutic epithelial-mesenchymal transition scores were lower in therapy responders than in nonresponders without reaching significance (p = .07). CONCLUSION We demonstrate that epithelial-mesenchymal transition correlates with severity of GER and presence of periprosthetic fistula enlargement in patients who underwent prosthetic voice rehabilitation, but epithelial-mesenchymal transition seems to be reversible upon PPI treatment in early stages only.
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Affiliation(s)
- Kai J Lorenz
- Department of Otorhinolaryngology - Head and Neck Surgery, Bundeswehrkrankenhaus Ulm, Ulm, Germany
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Hawkshaw MJ, Pebdani P, Sataloff RT. Reflux Laryngitis: An Update, 2009–2012. J Voice 2013; 27:486-94. [DOI: 10.1016/j.jvoice.2013.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 03/07/2013] [Indexed: 02/07/2023]
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Johnston N, Yan JC, Hoekzema CR, Samuels TL, Stoner GD, Blumin JH, Bock JM. Pepsin promotes proliferation of laryngeal and pharyngeal epithelial cells. Laryngoscope 2012; 122:1317-25. [PMID: 22570308 DOI: 10.1002/lary.23307] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 01/03/2012] [Accepted: 02/24/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE/HYPOTHESIS Laryngopharyngeal reflux (LPR) is thought to be a significant risk factor for laryngeal squamous cell carcinoma (SCC), but causality has never been proven. It is accepted that chronic reflux into the esophagus can induce metaplastic changes in esophageal mucosa with subsequent increased risk of esophageal adenocarcinoma, but no similar associations have been established for LPR and laryngopharyngeal SCC. The objective of this study was to test the hypothesis that reflux of pepsin into the laryngopharynx can promote carcinogenesis. STUDY DESIGN Translational research study. METHODS Normal human laryngeal primary epithelial cell cultures and hypopharyngeal FaDu SCC cells were exposed to human pepsin and analyzed by Human Cancer PathwayFinder and miRNA Superarrays, flow cytometry, and Western blot to determine the effect of pepsin on carcinogenesis. Laryngeal biopsy specimens taken from cancer patients and normal control subjects were analyzed for the presence of pepsin by Western blot. RESULTS Microarray analysis demonstrated that pepsin significantly altered the expression of 27 genes implicated in carcinogenesis and also affected the expression of 22 microRNAs known to be altered in human head and neck cancers. Pepsin increased proliferation in both FaDu SCC cells and cultured normal laryngeal epithelial primary cells by increasing S phase distribution on flow cytometry analysis in a time- and dose-dependent manner. Furthermore, pepsin was detected in 60% (3/5) human laryngeal cancer biopsies, absent in all (0/5) normal control specimens. CONCLUSIONS These data support a role for refluxed pepsin in the promotion of epithelial proliferation and carcinogenesis of the larynx and pharynx.
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Affiliation(s)
- Nikki Johnston
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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Loehrl TA, Samuels TL, Poetker DM, Toohill RJ, Blumin JH, Johnston N. The role of extraesophageal reflux in medically and surgically refractory rhinosinusitis. Laryngoscope 2012; 122:1425-30. [DOI: 10.1002/lary.23283] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 02/17/2012] [Accepted: 02/13/2012] [Indexed: 01/23/2023]
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Bock JM, Johnston N, Toohill RJ, Koszewski IJ, Samuels TL, Blumin JH. Extra-Esophageal Reflux and Laryngeal Disease: Update From a Translational Research Team. ACTA ACUST UNITED AC 2011. [DOI: 10.1044/vvd21.3.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Extraesophageal reflux (EER) has been implicated in a variety of different otorhinolaryngologic disorders including otitis media, chronic sinusitis, globus pharyngeus, laryngeal neoplasia, and many benign laryngeal disorders. New technologies such as multichannel intraluminal impedance studies have revolutionized our ability to detect the prevalence of EER, and the role of biomarker detection in diagnosing ongoing EER is evolving. Gastric refluxate contains not only hydrochloric acid, but also bile salts and digestive enzymes such as pepsin. Analysis of pepsin levels in both tissues and secretions is emerging as a useful adjunct in the diagnosis of EER and work to evaluate the role of pepsin in the promotion of laryngeal inflammation and neoplasia is ongoing. This review discusses the recent literature regarding the diagnosis and treatment of EER, and describes the controversies that can perhaps be further elucidated by ongoing clinical and translational research.
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Affiliation(s)
- Jonathan M. Bock
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin Milwaukee, WI
| | - Nikki Johnston
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin Milwaukee, WI
| | - Robert J. Toohill
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin Milwaukee, WI
| | - Ian J. Koszewski
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin Milwaukee, WI
| | - Tina L. Samuels
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin Milwaukee, WI
| | - Joel H. Blumin
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin Milwaukee, WI
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Blumin JH, Johnston N. Evidence of extraesophageal reflux in idiopathic subglottic stenosis. Laryngoscope 2011; 121:1266-73. [DOI: 10.1002/lary.21776] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 02/08/2011] [Accepted: 02/16/2011] [Indexed: 11/06/2022]
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