Analysis of saliva pepsin level in patients with tracheoesophageal fistula and voice prosthesis complications [Razina pepsina u slini bolesnika s komplikacijama traheoezofagealne fistule i govorne proteze]

Đanić Hadžibegović, Ana and Đanić, Davorin and Prgomet, Drago and Tićac, Robert and Kozmar, Ana (2012) Analysis of saliva pepsin level in patients with tracheoesophageal fistula and voice prosthesis complications [Razina pepsina u slini bolesnika s komplikacijama traheoezofagealne fistule i govorne proteze]. Collegium Antropologicum, 36 (S. 2). pp. 93-97. ISSN 0350-6134

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Abstract

The aim of this crossectional study was to investigate the relationship between pepsin concentration in saliva and the occurrence of tracheoesophageal fistula (TEF) complications and voice prosthesis (VP) complications, after total laryngectomy and VP implantation. We assessed the concentrations of pepsin in the saliva of 41 laryngectomized patients and correlated it with the incidence of TEF complications (periprostethic leakage, atrophy, esophageal mucosa hypertrophy, granulations, fistula enlargement, and VP dislocation), VP complications (transprosthetic leakage, Candida infection) and voice quality. Pepsin levels were measured by enzyme-linked immunoadsorbent assay (ELISA). Voice quality was assessed by Harrison-Robilard--Schultz (HRS) scale. In all, 17 (42%) patients had complications. All of them had TEF complications, whereas VP complication, together with TEF was found in 9 (22%) patients. We found no significant correlation between adjuvant radiotherapy and TEF complications. Most of patients, 30 (73%), had positive pepsin level in saliva. Median value of pepsin concentration in all patients was 4.8 (range 81.7). Median pepsin concentration was higher in patients free of TEF or VP complications (6.6, range 81.7 vs. 3.2, range 19.3) but that difference was not statistically significant (Mann-Whitney test, Z--1.562, p = 0.118). In addition, statistically insignificant negative correlation between pepsin levels and voice quality measured by HRS scale (Spearman's rho, p > 0.05). Although reflux was proposed as cause of TEF complications and pepsin has been proven as a most sensitive and specific marker of ekstraesophageal reflux, we did not find any statistically significant correlation between pepsin levels and occurrence of TEF or VP complications.

Abstract in Croatian

Cilj ovog istraživanja bio je proučiti odnose koncentracije pepsina u slini i učestalosti pojave komplikacija traheoezofagelane fistule (TEF) i komplikacija govorne proteze (GP) kod bolesnika s postavljenom GP nakon totalne laringektomije. U istraživanje je bio uključen 41 bolesnik čije su razine koncentracije pepsina u slini uspoređene s pojavom TEF komplikacija (curenje oko proteze, atrofija, hipertrofija sluznice jednjaka, granulacije, povećanje fistule i dislokacija GP), komplikacija GP (curenje kroz GP, infekcija Candidom) i kvalitetom glasa. Koncentracija pepsina u slini mjerena je »enzyme-linked immunoadsorbent assay« (ELISA) metodom. Kvaliteta glasa određena je prema Harrison-Robilard – Schultz (HRS) skali. Ukupno 17 (42%) bolesnika imalo je komplikaciju. Svi su imali komplikaciju TEF, dok je 9 (22%) imalo i komplikaciju GP. Nismo našli značajnu razliku u pojavi komplikacija TEF među bolesnicima koji su primili adjuvantu radioterapiju i koji nisu primili adjuvantu radioterapiju. Većina bolesnika, 30 (73%), ima pozitivnu razinu pepsina u slini. Medijan koncentracije pepsina u slini svih bolesnika je 4,8 (raspon 81,7). Medijan koncentracije pepsina bio je viši kod bolesnika bez komplikacije TEF i GP (6,6, raspon 81,7 vs. 3,2, raspon 19,3) ali razlika nije statistički značajna (Mann-Whitney test, Z –1,562, p=0,118). Također je nađena negativna korelacija između razine pepsina i kvalitete glasa, ali nije bila statistički značajna (Spearman’s rho, p>0,05). Iako se smatra kako ekstraezofagealni refluks želučanog sadržaja, čiji je najosjetljiviji marker razina pepsina, doprinosi pojavi komplikacija TEF i GP ovim istraživanjem nije nađeno značajne veze između razine pepsina i učestalosti komplikacija TEF i GP.

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