Abstract
It has been recently demonstrated that human esophageal submucosal mucous glands exhibit the ability to secrete copious amounts of mucin, well known within the gastrointestinal tract for its protective quality against hydrogen ion and pepsin. Since mucin may also play a protective role within the esophageal compartment, we have studied the rate of secretion of esophageal mucin in patients with RE. Mucin was assessed by periodic acid-Schiff methodology in esophageal secretion collected during continuous perfusion with saline (period I) followed by HCl (period II), HCl/pepsin (period III), and final saline (period IV), mimicking the natural gastroesophageal scenario. The basal rate of the luminal release of mucin in patients with grade II RE was 18% lower as compared with controls. During exposure of the esophageal mucosa to an HCl/pepsin solution, esophageal mucin output in the RE group was 52% lower than in the control group (0.154 ± 0.027 vs 0.320 ± 0.049 mg/cm2/min;P=0.025). Furthermore, the rates of esophageal mucin output in patients with grade III RE during esophageal perfusion with saline and HCl/pepsin were 62% (0.090 ± 0.021 vs 0.239 ± 0.036 mg/cm2/min;P=0.016) and 86% (0.048 ± 0.010 vs 0.320 ± 0.049 mg/cm2/min;P=0.001) lower when compared with corresponding values in controls. After endoscopic healing of RE, the overall impairment in the rate of esophageal mucin secretion in patients with grade II improved from 31% to 17% at the end of therapy, whereas in patients with grade III the impairment in mucin secretion improved only marginally from 71% to 69%. Significant impairment in the rate of esophageal mucin output in patients with severe esophagitis (grade III), prevailing despite healing of endoscopic changes, indicates that a low rate of esophageal mucin secretion may be a potential contributing factor in the development of severe mucosal damage in patients with excessive gastroesophageal reflux.
Similar content being viewed by others
References
Namiot Z, Sarosiek J, Rourk RM, McCallum RW: Human esophageal secretion: Mucosal response to luminal acid and pepsin. Gastroenterology 106:973–981, 1994
Murty VLN, Sarosiek J, Slomiany A, Slomiany BL: Effect of lipids and proteins on the viscosity of gastric mucus glycoprotein. Biochem Biophys Res Commun 121:521–529, 1984
Slomiany BL, Sarosiek J, Slomiany A: Gastric mucus and the mucosal barrier. Dig Dis 5:125–145, 1987
Namiot Z, Sarosiek J, McCallum RW: Secretory function of the esophageal mucosa in opossum: The role of cholinergic, peptidergic and histaminergic pathways. Am J Med Sci 1994 (submitted)
Sarosiek J, Namiot Z, Piascik R, Hetzel DP, Rourk RM, Edmunds MC, Daniel TM, McCallum RW: What part do the mucous cells of submucosal mucous glands play in the esophageal preepithelial barrier. Proc 4th Int Congress of O E S O Paris 1994 (in press)
Little AG, DeMeester TR, Kirchner PT, O'Sullivan GC, Skinner DB: Pathogenesis of esophagitis in patients with gastroesophageal reflux. Surgery 88:101–107, 1980
Eriksen CR, Cuschieri A: Diagnostic tests for gastroesophageal reflux disease.In Reflux Esophagitis. TPJ Hennessey, A Cushieri, JR Bennett (eds). London, Butterworths, 1989, pp 55–86
Sarosiek J, Yu Z, Hetzel DP, Rourk RM, Piascik R, Li L, Namiot Z, McCallum RW: Evidence on secretion of EGF by the esophageal mucosa in humans. Am J Gastroenterol 88:1081–1087, 1993
DeMeester TR, Johnson LF, Joseph GJ, Toscano MS, Hall AW, Skinner DB: Patterns of gastroesophageal reflux in health and disease. Ann Surg 184:459–470, 1976
Johnson LF: Historical perspectives on esophageal pH monitoring.In Ambulatory Esophageal pH Monitoring. JE Richter (ed). New York, Igaku-shoin, 1991, pp 1–11
Hirschowitz BI: A critical analysis, with appropriate controls, of gastric acid and pepsin secretion in clinical esophagitis. Gastroenterology 101:1149–1158, 1991
Walker V, Taylor WH: Pepsin secretion in chronic peptic ulceration. Gut 21:766–771, 1980
Mantle M, Allen A: A colorimetric assay for glycoprotein based on the periodic acid/Schiff stain. Biochem Soc Trans 6:607–609, 1978
Sarosiek J, Slomiany A, Takagi T, Slomiany BL: Hydrogen ion diffusion in dog gastric mucus glycoprotein: Effect of associated lipids and covalently bound fatty acids. Biochem Biophys Res Commun 118:523–531, 1984
Kasapidis P, Xynos E, Mantides A, Chrysos E, Demonakou M, Nikolopoulos N, Vassilakis JS: Difference in manometry and 24-h ambulatory pH-metry between patients with an without endoscopic or histological esophagitis in gastroesophageal reflux disease. Am J Gastroenterol 88:1893–1899, 1993
Robertson D, Ardersley M, Shepherd H, Smith CL: Patterns of acid reflux in complicated oesophagitis. Gut 28:1484–1488, 1987
Sarosiek J, Marshall BJ, Peura D, Hoffman S, Feng T, McCallum RW: Gastroduodenal mucus gel thickness in patients withHelicobacter pylori: A method for assessment of biopsy specimens. Am J Gastroenterol 86:729–734, 1991
Sarosiek J, Yu Z, Namiot Z, Rourk RM, Hetzel DP, McCallum RW: Impact of acid and pepsin on human esophageal prostaglandins. Am J Gastroenterol 89:588–594, 1994
Sarosiek J, McCallum RW: The evolving appreciation of the role of esophageal mucosal protection in the pathophysiology of gastroesophageal reflux disease. J Pract Gastroenterol 18:20J-20Q, 1994
Sarosiek J, Murty VLN, Nadziejko C, Slomiany A, Slomiany BL: Prostaglandin effect on the physical properties of gastric mucin and its susceptibility of pepsin. Prostaglandins 32:635–646, 1986
Sarosiek J, Namiot Z, Yu Z, Rourk RM, McCallum RW: The potential protective role of luminally released prostaglandins in patients with reflux eosphagitis. Am J Gastroenterol 88:1497, 1993 (abstract)
Sarosiek J, Slominay A, Slominay BL: Retardation of hydrogen ion diffusion by gastric mucus constituents: Effect of proteolysis. Biochem Biophys Res Commun 113:1053–1060, 1983
Scheiman JM, Kraus ER, Boland CR: Regulation of canine gastric mucin synthesis and phospholipid secretion by acid secretagogues. Gastroenterology 103:1842–1850, 1992
Badurski J, Sarosiek J, Bogdanikowa B, Glass GBJ: Comparative study of the effect of sulfated and non-sulfated mucin from the gastric juice on the proteolytic activity of pepsin. Proc 9th FEBS Meeting (Budapest) S2J101974 (abstract)
Morris GP, Harding RK, Wallace JL: A functional model for extracellular gastric mucus in the rat. Virch Arch (Cell Pathol) 46:239–251, 1984
Allen A: Structure and function of gastrointestinal mucus.In Physiology of the Gastrointestinal Tract. LR Johnson (ed). New York, Raven Press, 1981, pp 617–639
Neutra MR, Forstner JF: Gastrointestinal mucus: synthesis, secretion, and function.In Physiology of the Gastrointestinal Tract. LR Johnson (ed). New York, Raven Press, 1987, pp 975–1009
Bhaskar KR, Garik P, Turner BS, Bradley JD, Bansil R, Stanley HE, LaMont JT: Viscous fingering of HCl through gastric mucin. Nature 360:458–461, 1992
Greenwood B, Mantle M: Mucin and protein release in the rabbit jejunum: Effects of bethanechol and vagal nerve stimulation. Gastroenterology 103:596–505, 1992
Loomis RE, Prakobphol A, Levine MJ, Reddy MS, Jones PC: Biochemical and biophysical comparison of two mucins from human submandibular-sublingual saliva. Arch Biochem Biophys 258:452–464, 1987
Schrager J, Oates MDG: The isolation and partial characterization of the principal gastric glycoprotein of “visible mucus.” Digestion 4:1–12, 1971
Oemrawsingh I, Roukema PA: Isolation, purification and chemical characterization of mucins from human submandibular glands. Arch O
Sarosiek J, Hetzel D, Peura D, Piascik R, Feng T, McCallum RW: Human esophageal bicarbonate: The rate of secretion during perfusion with NaCl, HCl, and HCl/pepsin solutions. Gastroenterology 102:A158, 1992 (abstract)
Meyers RL, Orlando RC:In vivo bicarbonate secretion by human esophagus. Gastroenterology 103:1174–1178, 1992
Quigley EMM, Turnberg LA: pH of the microclimate lining human gastric and duodenal mucosain vivo: Studies in control subjects and in duodenal ulcer patients. Gastroenterology 92:1976–1984, 1987
Author information
Authors and Affiliations
Additional information
This project had been partly supported by AGA Foundation/SmithKline Beecham Clinical Research Award and Jeffress Trust grant J-240.
Rights and permissions
About this article
Cite this article
Namiot, Z., Sarosiek, J., Marcinkiewicz, M. et al. Declined human esophageal mucin secretion in patients with severe reflux esophagitis. Digest Dis Sci 39, 2523–2529 (1994). https://doi.org/10.1007/BF02087685
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02087685