Effect of Acid, Pepsin, and Bile Acid on the Stenotic... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTION: EDITORIAL

Effect of Acid, Pepsin, and Bile Acid on the Stenotic Progression of Traumatized Subglottis

1Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

2Department of Otolaryngology-Head and Neck Surgery, Cancer Research Institute, Chungnam National University College of Medicine, Daejeon, Republic of Korea

Reprint requests and correspondence: Jong-Lyel Roh, M.D., Ph.D., Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, South Korea.

The authors declared no conflicts of interest.

Received October 10, 2005; accepted January 3, 2006.

Abstract

BACKGROUND AND AIMS

Gastroesophageal reflux disease is related to various laryngeal sequelae. However, there is a lack of established reflux animal models covering longer observation periods. We evaluated the effects of acid, pepsin, and bile acid on healing of the traumatized subglottis in a simulated reflux model.

METHODS

In the first experiment, 48 rabbits were inflicted with a posterior subglottic injury using a diode laser, and there were 10 unwounded controls. After catheter insertion under transoral endoscopic guidance, animals were randomly assigned to one of the four groups: acid reflux (pepsin 0.3 mg/mL + taurodeoxycholic acid 0.155 mg/mL + acid pH 2); nonacid reflux (pepsin + taurodeoxycholic acid + pH 6); saline reflux; and unwounded control. Animals received catheter irrigation with 3 mL of a mixed solution or saline, twice daily for 6 wk. In the second experiment, 36 animals were inflicted with a subglottic injury followed by acid or saline reflux treatment and were sacrificed after 1, 2, and 4 wk for time-serial observations. Gross and histological findings were compared among the different groups.

RESULTS

Catheter-related problems were minor. Most animals received laryngopharyngeal irrigation with the solutions well, and 19 were excluded. Inflammation scores, fibrosis, thickening, and luminal stenosis were greatest in the acid reflux group (p < 0.005). Values were not different between the nonacid reflux and saline reflux groups (_p_ > 0.1).

CONCLUSIONS

Our data suggest that subglottic wound healing is significantly affected by pepsin and bile acid only under acidic conditions. This implies that acid-suppressive therapy can prevent further subglottic inflammation and stenosis by laryngeal reflux.