الفهرس | Only 14 pages are availabe for public view |
Abstract Pepsin is an enzyme whose precursor (pepsinogen) is released by the chief cells in the stomach. It degrades food proteins into peptides. So, its main site of synthesis and action is the stomach. Then, its presence in the esophagus or more proximally (pharynx or airways) suggests GER and may help in its diagnosis. Such a step may decrease the need for invasive methods for diagnosis of GERD as endoscopy and pH monitoring. This study was conducted on 75 patients with upper gastrointestinal symptoms who were indicated for upper gastrointestinal endoscopy with the aim of evaluating the role of salivary pepsin level as a non- invasive marker for diagnosis of GERD and its correlation with endoscopic severity of GERD. Patients were selected from endoscopy unit – Tropical medicine department, Menoufia university hospitals, in the period from September 2015 to April 2016. They were 33 males (44 %) & 42 females (56 %). Their ages ranged between 19 and 80 years with mean value 47.54 ± 15.52 years. In addition 20 healthy persons of matched age and sex were selected as control. Patients and controls were classified into the following groups: group I (GERD group): Included 50 patients with upper gastrointestinal symptoms consistent with Montreal definition & classification of GERD and in whom endoscopic evidences of GERD were confirmed. They were 24 males (48 %) & 26 females (52 %). Their ages ranged between 19 and 62 years with mean value 44.90 ± 15.10 years. group II (non GERD group): Included 25 patients with upper gastrointestinal symptoms not consistent with Montreal definition and classification of GERD and in whom endoscopic evidences of GERD were absent. They were 9 males (36 %) &16 females (64 %). Their ages ranged between 23 and 64 years with mean value 50.68 ±14.93 years. group III (control group): Included 20 healthy controls. They were 6 males (30 %) & 14 females (70 %). Their ages ranged between 21 and 62 years with mean value 42.45±12.3 years. For the purpose of the study, all studied groups were subjected to full and detailed history taking including esophageal and extraesophageal symptoms of GERD and other upper gastrointestinal symptoms, fulfilling GERD Q questionnaire, complete clinical examination and upper gastrointestinal endoscopy (for groups I & II ). All individuals of the 3 studied groups (patients and healthy controls) were asked to provide saliva samples after collection for 1 day. Samples were stored at -20 ○c and then pepsin was measured in all samples using ELISA kits based on Biotin antibody sandwich technology in which pepsin was added to the wells which are coated with monoclonal antibodies labeled with biotin. This assay employed the competitive inhibition enzyme immunoassay technique. Statistical analysis of the presenting data was done using SPSS method and revealed the following: Non-significant difference between studied groups as regard age and sex distribution. Classical GERD symptoms according to Montreal definition and classification were present in various proportions in all GERD group patients, while, none of these were present in non GERD group patients. None of studied patients had clinical evidences of chronic liver diseases. Highly significant increase of GERD Q questionnaire score in GERD group (score ≥ 8 in all patients of this group) when compared with non-GERD group (score < 8 in all patients of this group). Endoscopic evidences of GERD (esophageal mucosal breaks with different severity) were present in all GERD group patients while, they were absent in all non-GERD group patients. GERD was complicated with Barrett Esophagus in 8 patients and was associated with hiatus hernia in 21 patients. Los Angeles GERD classes A, B and C were present in 50%, 42% and 8% of GERD group patients respectively. None of patients had GERD class D on endoscopic examination. 185 Highly significant increase in the mean value of salivary pepsin in GERD group (88.64±46.37 ng/ mL) when compared with non-GERD (38.08±35.57 ng/ mL) and control (18.65±14.71 ng/ mL) groups, while there was no significant difference between non-GERD and control groups as regard mean values of salivary pepsin. Cut-off point of salivary pepsin level at highest sensitivity (81%) and specificity (81%) for diagnosis of GERD was 43.5 ng/ mL. Highly significant positive correlation between GERD Q questionnaire score and salivary pepsin level. Significant increase in the mean value of salivary pepsin level in Los Angeles grade C (129.5±37.25 ng/ mL) and B (103.95±38.69 ng/ mL) when compared with grade A (69.24±45.76 ng/ mL). Mean value of salivary pepsin in L.A. grade C was higher than mean value of salivary pepsin in L.A. grade B (though non-significant). Highly significant increase in the mean value of salivary pepsin in GERD patients complicated with BE (152.50±27.12 ng/ mL) when compared with patients without this complication (76.48 ±38.70 ng/ mL) |