Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Wahl, L.
Evaluation of the effect of the hormone status on the motility of the esophagus, as well as the gastrointestinal symptoms, of patients with a reflux associated disease
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2017. pp.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Öttl Karl
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- Abstract:
- Backround The gastroesophageal reflux disease (GERD) evolves when the backflow of gastric content into the esophagus leads to symptoms and/or complications (1). Identified as the main source of GERD is the dysfunctional antireflux barrier at the gastroesophageal junction. The reason for the dysfunction are multifactorial, like hiatal hernias, dysfunction of the LES, defect pressure barrier and non-sphincter associated reasons. Previously some authors suggested that the pathophysiology of GERD may be provoked by alterations of the hormone levels of the patients. Furthermore, the reason for motility disorders like achalasia and the influence of hormones on gastrointestinal symptoms are partly unknown. The aim of the study was to evaluate, if the hormones Thyroid stimulating hormone (TSH), Free Triiodothyronine (FT3), Free Tetraiodothyronine (FT4), gastrin, Vasoactive Intestinal Peptide (VIP) and calcitonin have an influence on GERD, motility disorders and gastrointestinal symptoms. Methods This was a prospective study with a cohort of 100 patients with symptoms of GERD. All patients underwent: high-resolution manometry (HRM), 24h-pH-Impedance-Monitoring and gastroscopy. For the evaluation of quality of life the Gastrointestinal quality of life index (GIQLI) was used, for evaluation of symptoms Reflux-symptom index (RSI) and symptom check list (SCL) were used. Out of the SCL four different scores were extracted to assess symptoms specific for reflux (heartburn, regurgitation, chest pain), non-typical reflux symptoms (cough, hoarseness, asthma, distortion of taste), gas-bloating-symptoms (fullness, bloating), and gastrointestinal symptoms (diarrhea, constipation, flatulence). Furthermore, blood samples were taken to analyze the levels of TSH, FT3, FT4, Calcitonin, VIP and Gastrin. After HRM the patients were subdivided into three groups according to the Chicago Classification. Group one represented patients with minor motility disorders. Group two included patients with EGJ outflow obstruction or major motility disorders. The third group represented “normal” patients. Results Complete data was available from 86 of 100 patients. The 86 patients had a median DeMeester score of 20,6. A pathological DeMeester was found in 45 patients with median score of 35, and respectively patients with GERD and without GERD. There have been no correlations between the DeMeester score and the hormones. Of the 86 patients, the median LES pressure was 23,6 mmHg, but no correlations were found between the different hormone levels and the LES-pressure. But a strong inverse relation between calcitonin and the Integrated Relaxation Pressure (IRP) of the esophagogastric junction (EGJ) was found (r= -0,492; p=0,000). No correlations were found between hormone levels and the mean scores of GIQLI, RSI and SCL. But positive correlations were found between VIP and GI-Symptoms (r=0,298; p= 0,011), as well as correlations between FT3 and dysphagia (r=0,283, p=0,016). Within the group II, TSH and FT4 correlated with outcomes of the SCL-questionnaire. FT4 correlated with the Typical-symptoms (p=0,002), as well as the GI-symptoms (diarrhea, constipation, flatulence) (p=0,039). TSH correlated with the Typical-symptoms (p=0,007). A regression analysis confirmed that these outcomes were no coincidence. Further within group II a correlation between VIP and the SCL-Gas-Bloat-Symptom (p=0,072) was found. Conclusion This study demonstrates that the hormones TSH, FT3, FT4, Calcitonin, VIP and Gastrin do not affect the motility of the esophagus. However, Calcitonin could have an effect on the function of the EGJ. Furthermore, thyroid hormones TSH, FT3 and FT4, as well as VIP seem to influence gastrointestinal symptoms. Further studies are needed to clarify in detail the role of these hormones and how these findings could find their way into clinical praxis.