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Salivary prostaglandin E2 is less likely to contribute to esophagoprotection by saliva in humans
S38
Abstracts
115 Salivary prostaglandin E2 is less likely to contribute to esophagoprotection by saliva in humans Tomasz Skoczylas, M.D., Cezary Poplawski, M.D., Marek Marcinkiewicz, M.D., Tomasz Zbroch, M.D., Richard W. McCallum, M.D. and Jerzy Sarosiek, M.D.*. 1GI Res. Lab., KUMC, Kansas City, KS. Purpose: Salivary secretion exhibits its esophagoprotective properties both in experimental animals and clinical scenario. An increase in the rate of salivary secretion during heartburn symptoms in patients with gastroesophageal reflux disease (GERD), mediated by the esophago-salivary reflex, is also a well established phenomenon. Salivary secretion stimulated by mastication exhibits a significantly enhanced protective potential (Gastroenterology, 110:675-81, 1996). Little is known, however, regarding the interrelationship between the rate of secretion of individual protective factors during stimulation by mastication and the esophago-salivary reflex. The aim of the study, therefore, was to explore the correlation between the rate of secretion of salivary volume and bicarbonate (BIC), non-bicarbonate (NBIC), protein (P), glycoconjugate (GL), epidermal growth factor (EGF), transforming growth factor alpha (TGF alpha) and prostaglandin E2 (PGE2) during stimulation by mastication or esophago-salivary reflex. Methods: The study was conducted in 33 asymptomatic volunteers (15F and 18 M; mean age of 39). Salivary secretions were collected in basal conditions, during mastication, and stimulation by the esophago-salivary reflex (evoked by intraesophageal HCI/pepsin, pH 2.1). Concentrations of salivary BIC and NBIC were measured by back-titration using TitraLab 900 (Radiometer Am. Inc., OH), protein by Lowry, glycoconjugate by PAS, EGF, TGFa and PGE2 by radioimmunoassays (Amersham, Arlington Heights, IL). Spearman correlation coefficient was calculated using SigmaStat software (Jandel Sci. San Rafael, CA). Results: In saliva stimulated by mastication statistically significant correlation was found between salivary volume and BIC, NBIC, protein, glycoconjugate, EGF, and TGFa output (P ⬍0.01). In saliva stimulated by esophago-salivary reflex, statistically significant correlation was also found between salivary volume and BIC, NBIC, protein, glycoconjugate, EGF, and TGFa output (P ⬍ 0.01). The rate of secretion of salivary PGE2 did not correlate with salivary volume both during stimulation by mastication and the esophago-salivary reflex (P⬎0.10). Conclusions: 1) The parallel increase in the content of major salivary buffers, protein, glycoconjugate, EGF, and TGF alpha, but not PGE2, during stimulation indicates that protective response within salivary glands is synchronized and independent of PGE2 generation. 2) PGE2 generated within salivary glands is less likely to play a significant role in salivary esophagoprotection.
116 Retrospective assessment of glucagon in esophageal food impactions Thomas C Sodeman MD1 and Todd H Baron MD1*. 1Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States. Purpose: Esophageal food impactions account for a significant number of emergent endoscopies. Glucagon is considered an effective therapy to dislodge impactions and obviate the need for endoscopy. However, the medical literature supporting its use consists mostly of case reports concerning its efficacy. AIM: To assess the efficacy of glucagon in the setting of acute food impactions. Methods: The records of all patients presenting to the emergency room with esophageal food impactions were reviewed from 1975 to 2000. The success of Glucagon was defined as relief of obstruction obviating the need for endoscopy. Results: Over the 25 year period, 222 patients were seen for food impaction (average age 59.51 ⫾ 22.81, 62.16% male). Of these, 106 patients received glucagon, which led to clinical resolution of the impaction in 10 (10.4%). 116 patients did not receive glucagon. Of this group, 20 spontaneously passed their bolus (20.8%). Although the glucagon and non-
AJG – Vol. 96, No. 9, Suppl., 2001
glucagon groups differed significantly in age (53.2 ⫾ 23.3 vs. 65.2 ⫾ 20.8 years), they had a similar Body Mass Indices (BMI) (27.5 ⫾ 4.70 vs. 27.6 ⫾ 5.54) and sex ratio (62.2% male vs. 62.0% male). The duration of impaction prior to presentation was not different (7.15 ⫾ 8.57 vs. 11.11 ⫾ 17.28 hours). Of those patients responding to Glucagon, there was no difference in age, sex, BMI, duration of impaction, or occurrence of a prior food impaction. Likewise, in those who spontaneously passed their food bolus without Glucagon, there was no difference in age, sex, prior impactions or BMI, although there was a significantly lower duration in time of impaction (3.26 ⫾ 5.83 vs. 12.44 ⫾ 18.23 hours) in the patients who did not receive glucagon but spontaneously passed their bolus. There was a significant difference in the dose of glucagon used between responders and non-responders (1.0 ⫾ 0 vs. 1.14 ⫾ 0.49 mg). Conclusions: 1. Glucagon may hinder the passage of an impacted food bolus rather than promote passage. 2. In the patients who clinically responded, a smaller dose of glucagon (1 mg) may be more effective than larger doses. 3. Further investigation of glucagon for food impaction via a randomized trial is warranted to determine an optimal dose and optimal patient characteristics, before the routine use of glucagon in food impactions can be recommended.
117 Profile of GERD: Attitudes toward the disease and their management strategies (care seeking behavior and knowledge of life style modifications) Ramesh Srinivasan1, Radu I Tutuian1, Marcelo F Vela1, T Isaac2, I Galaria2, June Castell1, Philip O Katz1* and Donald O Castell1. 1 Medicine, Graduate Hospital, Philadelphia, PA, United States; and 2 Medicine, Thomas Jefferson University, Philadelphia, PA, United States. Purpose: To assess in an urban population: 1) attitudes about the disease, 2) care seeking behavior, 3) knowledge of lifestyle modifications for relief. Methods: A sample from Philadelphia (410 subjects, with demographics comparable to the Philadelphia 1990 census) filled an 84-item in-person questionnaire regarding heartburn. Results: 70% of the total population considered heartburn (HB) a serious medical condition. This percentage remains the same regardless of gender, race or age, however rises to 85% if the individuals have been previously diagnosed with GERD. Related questions showed similar results. Would seek medical attention (Total 80%, Dx GERD 84%) MD could help (Total 83%, Dx GERD 81%) HB education needed (Total 70%, Dx GERD 81%) Care seeking behavior again is not affected by gender, race or age.
Would visit MD for HB ⬎2x wk Would visit MD for severe HB Would visit HB clinic for severe HB Have discussed their symptoms with MD Would ask about surgery for severe HB Take prescription medication Take over the counter (OTC) medication
Total
Dx GERD
66% 86% 41% 23% 28% 12% 42%
74% 97% 45% 57% 32% 52% 58%
While 71% of the total population believe there are medication and/or other treatments available they are not using, a much smaller percent are aware of life style modifications they can make to alleviate their symptoms. 65-83% were aware that elimination of alcohol, fat, chocolate and smoking would be of benefit but less that 40% (39-22%) were aware of the benefits of loose clothing, not lying down after meals and raising the head of the bed. Conclusions: The majority of the population believes heartburn is a serious medical problem that requires medical attention. Over 50% of the total take some form of medication (42% OTC) and those diagnosed with GERD are about 1/2 prescription and 1/2 OTC medication. Almost 1/3 of the subjects would consider surgery. With the exception of dietary modifications most people are not aware of things they can do to alleviate their symptoms.
Abstracts
115 Salivary prostaglandin E2 is less likely to contribute to esophagoprotection by saliva in humans Tomasz Skoczylas, M.D., Cezary Poplawski, M.D., Marek Marcinkiewicz, M.D., Tomasz Zbroch, M.D., Richard W. McCallum, M.D. and Jerzy Sarosiek, M.D.*. 1GI Res. Lab., KUMC, Kansas City, KS. Purpose: Salivary secretion exhibits its esophagoprotective properties both in experimental animals and clinical scenario. An increase in the rate of salivary secretion during heartburn symptoms in patients with gastroesophageal reflux disease (GERD), mediated by the esophago-salivary reflex, is also a well established phenomenon. Salivary secretion stimulated by mastication exhibits a significantly enhanced protective potential (Gastroenterology, 110:675-81, 1996). Little is known, however, regarding the interrelationship between the rate of secretion of individual protective factors during stimulation by mastication and the esophago-salivary reflex. The aim of the study, therefore, was to explore the correlation between the rate of secretion of salivary volume and bicarbonate (BIC), non-bicarbonate (NBIC), protein (P), glycoconjugate (GL), epidermal growth factor (EGF), transforming growth factor alpha (TGF alpha) and prostaglandin E2 (PGE2) during stimulation by mastication or esophago-salivary reflex. Methods: The study was conducted in 33 asymptomatic volunteers (15F and 18 M; mean age of 39). Salivary secretions were collected in basal conditions, during mastication, and stimulation by the esophago-salivary reflex (evoked by intraesophageal HCI/pepsin, pH 2.1). Concentrations of salivary BIC and NBIC were measured by back-titration using TitraLab 900 (Radiometer Am. Inc., OH), protein by Lowry, glycoconjugate by PAS, EGF, TGFa and PGE2 by radioimmunoassays (Amersham, Arlington Heights, IL). Spearman correlation coefficient was calculated using SigmaStat software (Jandel Sci. San Rafael, CA). Results: In saliva stimulated by mastication statistically significant correlation was found between salivary volume and BIC, NBIC, protein, glycoconjugate, EGF, and TGFa output (P ⬍0.01). In saliva stimulated by esophago-salivary reflex, statistically significant correlation was also found between salivary volume and BIC, NBIC, protein, glycoconjugate, EGF, and TGFa output (P ⬍ 0.01). The rate of secretion of salivary PGE2 did not correlate with salivary volume both during stimulation by mastication and the esophago-salivary reflex (P⬎0.10). Conclusions: 1) The parallel increase in the content of major salivary buffers, protein, glycoconjugate, EGF, and TGF alpha, but not PGE2, during stimulation indicates that protective response within salivary glands is synchronized and independent of PGE2 generation. 2) PGE2 generated within salivary glands is less likely to play a significant role in salivary esophagoprotection.
116 Retrospective assessment of glucagon in esophageal food impactions Thomas C Sodeman MD1 and Todd H Baron MD1*. 1Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States. Purpose: Esophageal food impactions account for a significant number of emergent endoscopies. Glucagon is considered an effective therapy to dislodge impactions and obviate the need for endoscopy. However, the medical literature supporting its use consists mostly of case reports concerning its efficacy. AIM: To assess the efficacy of glucagon in the setting of acute food impactions. Methods: The records of all patients presenting to the emergency room with esophageal food impactions were reviewed from 1975 to 2000. The success of Glucagon was defined as relief of obstruction obviating the need for endoscopy. Results: Over the 25 year period, 222 patients were seen for food impaction (average age 59.51 ⫾ 22.81, 62.16% male). Of these, 106 patients received glucagon, which led to clinical resolution of the impaction in 10 (10.4%). 116 patients did not receive glucagon. Of this group, 20 spontaneously passed their bolus (20.8%). Although the glucagon and non-
AJG – Vol. 96, No. 9, Suppl., 2001
glucagon groups differed significantly in age (53.2 ⫾ 23.3 vs. 65.2 ⫾ 20.8 years), they had a similar Body Mass Indices (BMI) (27.5 ⫾ 4.70 vs. 27.6 ⫾ 5.54) and sex ratio (62.2% male vs. 62.0% male). The duration of impaction prior to presentation was not different (7.15 ⫾ 8.57 vs. 11.11 ⫾ 17.28 hours). Of those patients responding to Glucagon, there was no difference in age, sex, BMI, duration of impaction, or occurrence of a prior food impaction. Likewise, in those who spontaneously passed their food bolus without Glucagon, there was no difference in age, sex, prior impactions or BMI, although there was a significantly lower duration in time of impaction (3.26 ⫾ 5.83 vs. 12.44 ⫾ 18.23 hours) in the patients who did not receive glucagon but spontaneously passed their bolus. There was a significant difference in the dose of glucagon used between responders and non-responders (1.0 ⫾ 0 vs. 1.14 ⫾ 0.49 mg). Conclusions: 1. Glucagon may hinder the passage of an impacted food bolus rather than promote passage. 2. In the patients who clinically responded, a smaller dose of glucagon (1 mg) may be more effective than larger doses. 3. Further investigation of glucagon for food impaction via a randomized trial is warranted to determine an optimal dose and optimal patient characteristics, before the routine use of glucagon in food impactions can be recommended.
117 Profile of GERD: Attitudes toward the disease and their management strategies (care seeking behavior and knowledge of life style modifications) Ramesh Srinivasan1, Radu I Tutuian1, Marcelo F Vela1, T Isaac2, I Galaria2, June Castell1, Philip O Katz1* and Donald O Castell1. 1 Medicine, Graduate Hospital, Philadelphia, PA, United States; and 2 Medicine, Thomas Jefferson University, Philadelphia, PA, United States. Purpose: To assess in an urban population: 1) attitudes about the disease, 2) care seeking behavior, 3) knowledge of lifestyle modifications for relief. Methods: A sample from Philadelphia (410 subjects, with demographics comparable to the Philadelphia 1990 census) filled an 84-item in-person questionnaire regarding heartburn. Results: 70% of the total population considered heartburn (HB) a serious medical condition. This percentage remains the same regardless of gender, race or age, however rises to 85% if the individuals have been previously diagnosed with GERD. Related questions showed similar results. Would seek medical attention (Total 80%, Dx GERD 84%) MD could help (Total 83%, Dx GERD 81%) HB education needed (Total 70%, Dx GERD 81%) Care seeking behavior again is not affected by gender, race or age.
Would visit MD for HB ⬎2x wk Would visit MD for severe HB Would visit HB clinic for severe HB Have discussed their symptoms with MD Would ask about surgery for severe HB Take prescription medication Take over the counter (OTC) medication
Total
Dx GERD
66% 86% 41% 23% 28% 12% 42%
74% 97% 45% 57% 32% 52% 58%
While 71% of the total population believe there are medication and/or other treatments available they are not using, a much smaller percent are aware of life style modifications they can make to alleviate their symptoms. 65-83% were aware that elimination of alcohol, fat, chocolate and smoking would be of benefit but less that 40% (39-22%) were aware of the benefits of loose clothing, not lying down after meals and raising the head of the bed. Conclusions: The majority of the population believes heartburn is a serious medical problem that requires medical attention. Over 50% of the total take some form of medication (42% OTC) and those diagnosed with GERD are about 1/2 prescription and 1/2 OTC medication. Almost 1/3 of the subjects would consider surgery. With the exception of dietary modifications most people are not aware of things they can do to alleviate their symptoms.