Analysis of pepsin in tracheoesophageal puncture sites. Ann Otol Rhinol Laryngol 2010 Dec;119(12):799-805
Date
01/22/2011Pubmed ID
21250551DOI
10.1177/000348941011901203Scopus ID
2-s2.0-78649949414 (requires institutional sign-in at Scopus site) 14 CitationsAbstract
OBJECTIVES: Tracheoesophageal puncture (TEP) and prosthesis insertion is a well-established method of voice rehabilitation after laryngectomy. Maintenance of the prosthesis and tract can be challenging, and reflux to the TEP site has been proposed as a cause. The sites of TEP were evaluated for the presence of pepsin in tissue biopsy specimens and tract secretions to explore this association.
METHODS: Patients with TEP were interviewed for a history of symptoms related to reflux, medication use history, TEP voice quality, and incidence of TEP complications. Tissue biopsy specimens and tract secretions were obtained from TEP sites and analyzed for the presence of pepsin via sodium dodecyl sulfate-polyacrylamide gel electrophoresis Western blot analysis.
RESULTS: Twelve of 17 patients (47%) had some history of preoperative or postoperative symptoms of gastroesophageal reflux disease or laryngopharyngeal reflux. Pepsin was present within the TEP site in a total of 10 of 17 patients (58%; 7 of 17 tissue biopsy specimens and 6 of 7 secretion samples). There were no statistically significant associations between the presence of pepsin and sex, reflux history, use of acid suppressive medicine, or time since laryngectomy.
CONCLUSIONS: Reflux with subsequent pepsin deposition into the TEP tract occurs in a majority of laryngectomy patients. Further studies on the effect of reflux on the health and function of the TEP tract are warranted.
Author List
Bock JM, Brawley MK, Johnston N, Samuels T, Massey BL, Campbell BH, Toohill RJ, Blumin JHAuthors
Joel H. Blumin MD Chief, Professor in the Otolaryngology department at Medical College of WisconsinJonathan Bock MD Professor in the Otolaryngology department at Medical College of Wisconsin
Bruce H. Campbell MD Emeritus Professor in the Otolaryngology department at Medical College of Wisconsin
Nikki Johnston PhD Professor in the Otolaryngology department at Medical College of Wisconsin
Becky Massey MD Associate Professor in the Otolaryngology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedEsophagus
Female
Gastroesophageal Reflux
Humans
Laryngectomy
Laryngopharyngeal Reflux
Larynx, Artificial
Male
Middle Aged
Pepsin A
Prosthesis Implantation
Punctures
Trachea