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Analysis of pepsin in tracheoesophageal puncture sites. Ann Otol Rhinol Laryngol 2010 Dec;119(12):799-805

Date

01/22/2011

Pubmed ID

21250551

DOI

10.1177/000348941011901203

Abstract

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 JH

Authors

Joel H. Blumin MD Chief, Professor in the Otolaryngology department at Medical College of Wisconsin
Jonathan Bock MD Associate Professor in the Otolaryngology department at Medical College of Wisconsin
Bruce H. Campbell MD Professor in the Otolaryngology department at Medical College of Wisconsin
Nikki Johnston PhD Associate 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

Aged
Esophagus
Female
Gastroesophageal Reflux
Humans
Laryngectomy
Laryngopharyngeal Reflux
Larynx, Artificial
Male
Middle Aged
Pepsin A
Prosthesis Implantation
Punctures
Trachea
jenkins-FCD Prod-480 9a4deaf152b0b06dd18151814fff2e18f6c05280