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Stimulated saliva secretion is reduced in proton pump inhibitor-resistant severe reflux esophagitis patients

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Abstract

Background

Salivary secretion in patients with proton-pump inhibitor (PPI)-resistant severe reflux esophagitis has not been examined. In this study, saliva secretion and salivary epidermal growth factor (EGF) in patients with PPI-resistant severe reflux esophagitis were investigated.

Methods

We recruited 22 PPI-resistant and 22 PPI-responsive severe reflux esophagitis patients who were not infected with Helicobacter pylori. Saliva secretion testing and esophageal manometry using high-resolution manometry were performed. Saliva secretion was assessed as follows: each patient chewed sugar-free gum for 3 min prior to endoscopy and the amount and pH of saliva as well as the pH of saliva after acid loading as an index of the acid-buffering capacity were measured. The salivary EGF concentration was assessed by ELISA.

Results

The amount of saliva secreted was significantly lower in the PPI-resistant group than in the PPI-responsive group, with medians (25th-75th percentile) of 3.7 (2.2–6.8) and 4.9 (4.0–7.8) mL, respectively (p = 0.029). Salivary pH was significantly lower in the PPI-resistant group [6.9 (6.7–7.2)] than in the PPI-responsive group [7.2 (7.1–7.4), p = 0.001]. Salivary pH after acid loading was significantly lower in the PPI-resistant group [5.6 (5.3–5.9)] than in the PPI-responsive group [6.4 (6.1–6.5), p = 0.002]. The salivary EGF concentration was significantly higher in the PPI-resistant group [3211.5 (1865.0–4121.5)] than in the PPI-responsive group [1816.0 (1123.5–2792.3), p = 0.041]. No significant differences were observed in the proportion of esophageal motility abnormalities.

Conclusion

Stimulated saliva secretion was reduced in PPI-resistant severe reflux esophagitis patients.

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Acknowledgements

The authors thank Ms. Satoko Nishimura for her administrative assistance.

Funding

This work was supported by JSPS KAKENHI Grant Number JP20K082973.

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Authors and Affiliations

  1. Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Tomohide Tanabe, Mai Koeda, Eri Momma, Yoshimasa Hoshikawa, Shintaro Hoshino, Noriyuki Kawami, Mitsuru Kaise & Katsuhiko Iwakiri

  2. Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan

    Yuichi Kitasako

  3. Dental Clinic, Ministry of Foreign Affairs, 2-2-1, Kasumigaseki, Chiyoda-ku, Tokyo, Japan

    Yuichi Kitasako

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  1. Tomohide Tanabe
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Contributions

TT: tanabe@nms.ac.jp: Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. MK: m-koeda@nms.ac.jp: Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. YK: kitaodnt@tmd.ac.jp: Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University,1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan. EM: eri-momma@nms.ac.jp: Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. YH: y-hoshikawa@nms.ac.jp: Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. SH: hoshino.tmhccm@rd5.so-net.ne.jp: Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. NK: s5038@nms.ac.jp: Nippon Medical School, Graduate School of Medicine, 1–1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. MK: m-kaise@nms.ac.jp: Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. KI: k-iwa@nms.ac.jp: Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.

Corresponding author

Correspondence to Katsuhiko Iwakiri.

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Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

Conflict of interest

Katsuhiko Iwakiri has received lecture fees from Takeda Pharmaceutical Co., Ltd. and Otsuka Pharmaceutical Co., Ltd. The remaining authors declare that they have no conflicts of interest.

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Tanabe, T., Koeda, M., Kitasako, Y. et al. Stimulated saliva secretion is reduced in proton pump inhibitor-resistant severe reflux esophagitis patients. Esophagus 18, 676–683 (2021). https://doi.org/10.1007/s10388-021-00825-1

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