Document Detail


Simulated reflux decreases vocal fold epithelial barrier resistance.
MedLine Citation:
PMID:  20564752     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES/HYPOTHESIS: The vocal fold epithelium provides a barrier to the entry of inhaled and systemic challenges. However, the location of the epithelium makes it vulnerable to damage. Past research suggests, but does not directly demonstrate, that exposure to gastric reflux adversely affects the function of the epithelial barrier. Understanding the nature of reflux-induced epithelial barrier dysfunction is necessary to better recognize the mechanisms for vocal fold susceptibility to this disease. Therefore, we examined the effects of physiologically relevant reflux challenges on vocal fold transepithelial resistance and gross epithelial and subepithelial appearance. STUDY DESIGN: Ex vivo, mixed design with between-group and repeated-measures analyses. METHODS: Healthy, native porcine vocal folds (N = 52) were exposed to physiologically relevant acidic pepsin, acid-only, or pepsin-only challenges and examined with electrophysiology and light microscopy. For all challenges, vocal folds exposed to a neutral pH served as control. RESULTS: Acidic pepsin and acid-only challenges, but not pepsin-only or control challenges significantly reduced transepithelial resistance within 30 minutes. Reductions in transepithelial resistance were irreversible. Challenge exposure produced minimal gross changes in vocal fold epithelial or subepithelial appearance as evidenced by light microscopy. CONCLUSIONS: These findings demonstrate that acidic environments characteristic of gastric reflux compromise epithelial barrier function without gross structural changes. In healthy, native vocal folds, reductions in transepithelial resistance could reflect reflux-related epithelial disruption. These results might guide the development of pharmacologic and therapeutic recommendations for patients with reflux, such as continued acid-suppression therapy and patient antireflux behavioral education.
Authors:
Elizabeth Erickson; Mahalakshmi Sivasankar
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Laryngoscope     Volume:  120     ISSN:  1531-4995     ISO Abbreviation:  Laryngoscope     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-28     Completed Date:  2010-08-16     Revised Date:  2010-09-02    
Medline Journal Info:
Nlm Unique ID:  8607378     Medline TA:  Laryngoscope     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1569-75     Citation Subset:  IM    
Affiliation:
Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Disease Models, Animal
Electric Impedance
Gastroesophageal Reflux / physiopathology*
Gastrointestinal Agents / pharmacology*
Hydrochloric Acid / pharmacology*
Laryngeal Mucosa / drug effects,  physiopathology*
Pepsin A / pharmacology*
Regurgitation, Gastric / physiopathology
Swine
Vocal Cords / drug effects,  physiopathology*
Grant Support
ID/Acronym/Agency:
R03 DC008690-02/DC/NIDCD NIH HHS; R03 DC008690-03/DC/NIDCD NIH HHS
Chemical
Reg. No./Substance:
0/Gastrointestinal Agents; 7647-01-0/Hydrochloric Acid; EC 3.4.23.1/Pepsin A

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