Increased levels of prostaglandins and nitric oxide in esophageal mucosa of children with reflux esophagitis

Background: Prostaglandin E-2 (PGE(2)) is said to be both protective and detrimental for esophageal mucosal integrity. Nitric oxide (NO) controls several esophageal neuromuscular functions, including relaxation of the lower esophageal sphincter. The purpose of this study was to verify PGE, and NO levels in esophageal mucosa of children with reflux esophagitis. Methods: The patients were 10 children. age range 7 to 12 years, affected by reflux esophagitis. The control subjects were 10 children, age range 6 to 11 years, with recurrent abdominal pain. Tissue fragments obtained by esophageal biopsies were placed in a culture medium and processed to obtain a cell suspension. Cells were incubated for 24 hours at 37 degrees C. Thereafter, supernatants were collected and divided into aliquots to determine the amounts of PGE(2) and NO metabolites. Results: Esophageal cells obtained from reflux esophagitis patients synthesize and release a significantly higher (p < 0.01) amount of PGE(2) and NO (PGE(2) 1.9 +/- 0.56 ng/10(6) cells per 24 hours; NO 124.94 +/- 18.36 mu M/10(6) cells per 24 hours) than did the control group (PGE(2) 0.66 +/- 0.14 ng/10(6) cells per 24 hours; NO 68.03 +/- 12.3 mu M/10(6) cells per 24 hours). Conclusions: These results suggest that in esophageal mucosa, PGE(2) and NO, in low concentrations, are protective, whereas, at high doses, they can be harmful. Higher amounts of PGE(2) and NO in the esophageal mucosa of reflux esophagitis patients suggest that similar noxious stimuli trigger the inducible forms of the respective enzyme

Sandifer's syndrome in a breast-fed infant

Sandifer's syndrome is a rare manifestation of gastroesophageal reflux (GER) in children, occurring in association with abnormal movements of the head, neck, and upper part of the trunk. Out of 65 children with Sandifer's syndrome described in literature, only 2 were breast-fed. We report on a 15-day-old breast-fed girl affected by Sandifer's syndrome. Pathological GER was diagnosed with 24 h pH esophageal monitoring. In our patient, all the symptoms of Sandifer's syndrome disappeared when she was cow's milk formula-fed. The role of food allergy to dietary proteins ingested by a lactating mother is discussed

Increased taurine content in esophageal mucosa of children affected by gastroesophageal reflux

We studied the possible involvement of mucosal amino acid metabolism in the pathogenesis of gastroesophageal reflux disease in children. Eighteen children with gastroesophageal reflux disease (8 with reflux esophagitis and 10 without) and 10 children with normal 24-h esophageal pH monitoring as a comparative group underwent esophagogastroduodenoscopy with biopsies. Plasma and esophageal mucosa amino acids were assayed by liquid chromatography. In children affected by gastroesophageal reflux disease we found an increase of mucosal taurine (P < 0.01) and a decrease of serine (P < 0.01). No differences were noted between patients with and without esophagitis. Significant positive correlations (P < 0.001; r = 0.626) were found between mucosal taurine content and reflux index. Plasma amino acid concentrations did not show any significant differences among groups. Our results indicate that biochemical alterations precede the histological findings of inflammation, likely reflecting the adaptive response of the esophageal mucosa to the gastric contents exposure