691 The Role of PPARγ Modulation in the Growth Inhibition of Hepatocellular Carcinoma Cells

Abstract

Background: It has been reported that weakly acidic pharyngeal gas reflux is significantly increased in patients with reflux laryngitis. However, the diagnosis of reflux laryngitis is controversial. Therefore, we studied patients with chronic cough who responded to fulldose PPI therapy, in whom 24-hr pharyngoesophageal impedance and pH monitoring was performed. Methods: Ten patients with chronic cough responding to PPIs (CC)(24-74 yrs; 3F), 10 with GERD (GE)(20-73; 2F), and 10 healthy controls (C)(22-72; 4F) underwent ambulatory 24-hr concurrent pharyngoesophageal impedance and pH monitoring. Three types of new impedance/pH catheters (ZAI-S62C12E-14E, Sandhill Scientific Inc., CO) were used to detect esophagopharyngeal reflux with a Sleuth GER monitoring system. The subjects ate ad libitum and were instructed to record events such as coughing by using an event marker. Weakly acidic reflux was defined as a pH drop of more than 1 unit with a nadir pH > 4. The symptom association probability (SAP) method was used to analyze the relation between gastroesophageal reflux and cough. In 6 CC patients, 24-hr monitoring was repeated on treatment after 8 weeks full-dose PPI therapy. Symptoms were evaluated using Frequency scale for the symptoms of GERD (FSSG). Results: Weakly acidic pharyngeal gas reflux events were observed in 8 out of 10 CC patients, and were significantly increased in the CC versus GE or C groups (p<0.05). Acidic and weakly acidic esophagaopharyngeal reflux (EPR) events were only observed in CC patients and were always induced by swallowing and occurred during acid liquid or mixed reflux events in the proximal esophagus. Swallow-induced acidic and weakly acidic EPR was significantly increased in the CC versus GE or C groups (p<0.05). Among 10 CC patients, 9 had weakly acidic and/or acidic EPR events, while only one had pure non-acidic EPR events. This patient and 2 other CC patients showed a positive association between gastroesophageal reflux and cough on SAP analysis. In 6 CC patients, PPIs abolished swallow-induced weakly acidic and/or acidic reflux, while weakly acidic pharyngeal gas reflux events decreased significantly and symptoms improved significantly compared with before therapy (p<0.05). Conclusion: Most patients with chronic cough responding to PPIs had minor acidic gas reflux and/or swallow-induced weakly acidic and/or acidic reflux in the pharynx. A direct effect of acidic mist or acidic liquid refluxing into the pharynx was suggested to be the cause of their chronic cough. In some patients, symptoms may arise indirectly from gastroesophageal reflux via a vago-vagal reflex.