Does the healing of the esophageal mucosa improve the function of the esophageal submucosal and salivary glands?

Abstract

The esophageal pre-epithelial barrier encompasses components of secretions from both the esophageal submucosal and salivary glands. We demonstrated, in patients with reflux esophagitis (RE), significantly diminished luminal release of esophageal epidermal growth factor (EGF). The rate of luminal release of esophageal prostaglandin E (PGE ) was significantly higher compared with controls and significantly declined after healing of RE. Patients with RE also exhibited significant declines in esophageal mucin secretion; however, after healing of RE with rabeprazole, this rate increased significantly. The rate of salivary EGF and bicarbonate secretion in patients with RE was significantly lower than in controls. We have demonstrated that mastication of tasteless parafilm, which could be substituted with sugarless chewing gum in the clinical scenario, resulted in profound and significant increases in the rate of secretion of salivary protective factors, such as bicarbonate, mucin, protein, EGF, and PGE , in patients with RE. Our data clearly indicate that there is a relationship between the form or the structure of the esophageal mucosa and the secretory function of not only the esophageal submucosal glands but also the salivary glands. Application of masticatory stimulation in a clinical scenario may also have some therapeutic potential.

The microscopic anatomy of the esophagus including the individual layers, specialized tissues, and unique components and their responses to injury

“…Submucosal glands and ducts play an important role in maintaining the seromucinous pre‐epithelial barrier of the squamous mucosa . They secrete biologically active peptides, including trefoil factor family 3, epidermal growth factor, transforming growth factor‐alpha, and prostaglandin E2 to maintain the integrity of the squamous mucosa .…”

“…Function and microanatomy of submucosal glands and ducts Submucosal glands and ducts play an important role in maintaining the seromucinous pre-epithelial barrier of the squamous mucosa. 73 They secrete biologically active peptides, including trefoil factor family 3, epidermal growth factor, transforming growth factor-alpha, and prostaglandin E2 to maintain the integrity of the squamous mucosa. 74 Submucosal glands also secrete a variety of defensive cell products; neutral and sialylated mucins prevent viruses and bacteria from infiltrating the underlying mucosa, lysozymes are bactericidal, and pepsinogen is activated to pepsin, which contributes to proteolysis.…”

Chronic fibrosing esophagitis with diffuse esophageal intramural pseudo‐diverticulosis

“…These would result in a narrow lumen, reduced peristalsis, and poor lubrication, which together may explain the high incidence of food impactions. 37,38 In this context, the pseudodiverticula, which gave the disease its name, would rather be a secondary phenomenon and not crucial for the development of symptoms.…”

“…Although symptoms vary during the course of the disease, the underlying chronic inflammation of the submucosa and its glands will continue for months or years, the end stage being submucosal fibrosis and glandular dysfunction. These would result in a narrow lumen, reduced peristalsis, and poor lubrication, which together may explain the high incidence of food impactions 37,38 . In this context, the pseudo‐diverticula, which gave the disease its name, would rather be a secondary phenomenon and not crucial for the development of symptoms.…”

Clinical and endoscopic characteristics of diffuse esophageal intramural pseudo-diverticulosis

“…Functionally, inflammation and destruction of submucosal glands will lead to impaired lubrication, sclerosis, and trachealization to impaired peristalsis [32,36,37]. Both phenomena together explain the high rate of dysphagia and food impactions in DEIPD patients.…”