الفهرس 
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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.
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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)