Significant Increase of Esophageal Mucin Secretion in Patients with Reflux Esophagitis After Healing with Rabeprazole: Its Esophagoprotective Potential

Abstract

Esophageal mucin secretion in patients with reflux esophagitis (RE) is significantly impaired. Rabeprazole augments gastric mucin secretion. We have studied, therefore, the effect of rabeprazole on esophageal mucin secretion in patients with RE. The study was conducted in 15 patients with RE treated with rabeprazole (20 mg QD) for 8 weeks. Esophageal secretions were collected during consecutive infusions of initial NaCl, HCl/Pepsin (HCl/P), and a final NaCl, using a specially designed esophageal catheter, before and after therapy. Mucin was measured using standard methodology. After rabeprazole administration esophageal mucin concentration as well as secretion increased during perfusion with initial saline (P < 0.01), HCl/P (P < 0.02), and concluding saline (P < 0.001). Stimulation of esophageal mucin secretion by rabeprazole may indicate that the mechanisms governing its secretion are similar to those implicated in gastric mucin output. Enhancement of esophageal mucin secretion by rabeprazole may translate into esophagoprotective potential in patients with reflux esophagitis.

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

“…Of note, the rate of esophageal mucin secretion also remained significantly lower in patients with grade II RE (erosions on more than one longitudinal fold) during esophageal mucosal exposure to HCl/pepsin ( P < 0.05) and during mucosal exposure to final saline ( P < 0.05) . Interestingly, in patients with RE (grades A, B, and C according to the LA classification) after healing of esophageal mucosal erosions with PPI rabeprazole, the rate of esophageal mucin secretion increased significantly in basal conditions (i.e., during esophageal mucosal exposure to saline ( P < 0.01)), during esophageal mucosal perfusion with HCl ( P < 0.05), and during the final mucosal exposure to saline ( P < 0.001)) …”

“…16 Interestingly, in patients with RE (grades A, B, and C according to the LA classification) after healing of esophageal mucosal erosions with PPI rabeprazole, the rate of esophageal mucin secretion increased significantly in basal conditions (i.e., during esophageal mucosal exposure to saline (P < 0.01)), during esophageal mucosal perfusion with HCl (P < 0.05), and during the final mucosal exposure to saline (P < 0.001)). 17 One may wonder how strong the esophageal submucosal mucus gland secretions are in patients with NERD. We explored this phenomenon and demonstrated that these patients secreted significantly more (P < 0.05) esophageal mucin during esophageal mucosal exposure to HCl than controls, significantly more (P < 0.05) esophageal protein during esophageal mucosal perfusion with HCl/pepsin, but significantly less (P < 0.05) nonbicarbonate buffers during esophageal mucosal exposure to HCl and HCl/pepsin and significantly less (P < 0.05) esophageal TGF-␣ during esophageal mucosal perfusion with final saline than controls.…”

Barrett's esophagus: proton pump inhibitors and chemoprevention I

“…9 Although therapy with PPIs improves the equilibrium between aggressive factors and protective mechanisms by diminishing acidity of GER, some PPIs, such as rabeprazole, may also increase esophageal secretion of protective mucin after healing of erosive mucosal changes. 10 Administration of the serotonin receptor (5-HT 4 ) agonist tegaserod, and potentially other newer agents free of cardiac side effects, results in significant increase in salivary bicarbonate and nonbicarbonate buffers, EGF, and TGF-␣, as well as esophageal EGF, 6 promoting further potential restoration of equilibrium. This enhancement of equilibrium can be also promoted further by mastication or chewing sugarless chewing gum, which leads to a two-to fourfold increase in salivary buffers, mucin, EGF, and TGF-␣.…”

Choice of protonic pump inhibitor with regard to multimorbidity: a focus on rabeprazol

“…В клинической практике наличие гастропротективного эффекта рабепразола нашло подтверждение в работах исследователей Медицинского центра Университета Канзаса (США) [71][72][73]. Так, после 7-дневного приема рабепразола в дозе 20 мг было установлено повышение уровня ряда гастропротективных компонентов в желудочном секрете: достоверное увеличение количества защитной слизи, концентрации муцина и вязкости желудочного сока в базальную и стимулированную пентогастрином фазы желудочной секреции [71].…”