Pepsin Levels Research Articles

Comparative Effect of Curcuma longa and Piper nigrum Extract and their Mixture on some Gastric Secretory Parameters of Indomethacin-induced Gastric Ulceration in Albino Rats

Peptic ulcer disease (PUD) which includes gastric and duodenal ulcer is one of the unresolved medical problems facing numerous patients in a wide range of age of both sexes worldwide. Many medicinal plants are known to exhibit antiulcer activity and some have been confirmed scientifically to possess gastro protective and antiulcer property and also found to be useful in its treatment. Among these medicinal plants turmeric (Curcuma longa) and black pepper (Piper nigrum) have been reported to possess gastroprotective potentials. However, the effect of the combination of turmeric and black pepper on some gastric secretory parameters of ulcerated rats hasn’t been considered. As a result, this study was designed to evaluate the effect of ethanol extract of Curcuma longa and Piper nigrum on some gastric secretory parameters of indomethacin induced gastric ulceration in albino rats. Total of sixty (60) albino rats was used for this study. After acclimatization for 14 days, the animals were randomly allocated into six groups (n=10).Group A (normal control): rats was fed on pellet and allowed free access to water, rats in Group B (Ulcerated control) were given only indomethacin at a dose of 50mg/Kg body weight. Animals in group C (Standard control) was given indomethacin after pre treatment with esomperazole (20mg/kg) body weight. Group D, E, and F comprised ulcerated rats pre treated with turmeric (200mg/kg body weight), black pepper (100mg/kg body weight), turmeric and black pepper (200mg/Kg + 100mg/kg respectively) body weight. Treatments with the reference drug and extracts lasted for 21 days prior to ulcer induction on the twenty-third day.4 h post ulcer induction, the animals were humanely sacrificed under chloroform anaesthesia and gastric content drained into a centrifuge tube for further studies on some gastric secretory parameters. The study showed that TA levels were significantly (p < 0.05) higher in group B compared to the control group and all other groups. Conversely, TA levels were significantly (p < 0.05) lower in groups C, D, E, and F compared to the control, with group F showing the lowest levels among these, particularly lower than groups C and E. GpH levels were significantly (p < 0.05) lower in group B when compared to groups C, D, E, and F. However, GpH levels were significantly (p < 0.05) higher in groups D and E compared to the control, with group E having higher GpH levels than group C. Additionally, pepsin levels were significantly (p < 0.05) elevated in group B relative to the control and other groups. Pepsin levels were also significantly (p < 0.05) higher in groups C, D, E, and F compared to the control, with group C having lower levels than groups D and E. It can therefore concluded based on the findings of this study that the combination of turmeric and black pepper extract had more gastroprotective effect than the individual extracts alone suggestive of the synergistic effect of these plants in the management of peptic ulcer disease. Keywords: Curcuma longa, Piper nigrum, Indomethacin and Gastric Ulceration

Chalcones as potential pepsin inhibitors: Synthesis, characterization, DFT and molecular docking studies

Pepsin, a unique protease activity at acidic environment in the stomach, can cause chronic inflammation in surrounding tissues after becoming hyperactive lead to enlarged tonsils, vocal fold polyps, laryngopharyngeal cancers, and other diseases. Therefore, design and development of new effective pepsin inhibitors becomes significant. In the present work, we synthesized, and characterized thiophene-based chalcones as anti-pepsin agents. The synthesized chalcones exhibited significantly better pepsin inhibition than commercially available drugs omeprazole and pantoprazole. The in-vitro screening revealed that the synthesized compounds exhibited pepsin inhibition in the range of 53.19–91.14 % at 3 × 10−8 M concentration showing promising results controlling elevated pepsin levels. Compound 3p was found the best inhibitor with an IC50 value 1.02 × 10−9 M. Molecular docking studies executed show the decrease in energy of interaction between pepsin and the synthesized compounds 3(a-t) varies from −69.104 to −83.124 kcal/mol and the highest decreased interaction energy with compound 3p. DFT analyses were conducted to gain a deeper understanding of the structural parameters. Energy minimization and quantum chemical parameters computed using Avagadro and ORCA software indicated ΔE values in the range 9.593–10.246 eV as per DFT calculations. The results obtained from the in vitro studies were supported with in silico studies.

Decreased Amino Acid Transporter LAT2 Is the Main Determinant of Impaired Protein Utilization During Aging

As the global demographic shifts toward an aging population, understanding the efficiency of protein utilization in older adults becomes crucial. Our study explores the intricate relationship between protein intake and aging, with a focus on precision nutrition for older people. Through a meta-analysis, we confirm a decline in protein-utilization capacity in older individuals and examine the different contributions of plant and animal protein. In experiments involving mice of different ages, older mice exhibited decreases in the biological utilization of four proteins (casein, beef protein, soy protein, and gluten), particularly casein. In subsequent research, casein was studied as a key protein. A decline in gastric digestion function was observed through peptidomics and the examination of pepsin levels using casein. Nevertheless, this decline did not significantly affect the overall protein digestion during the aging process. The combined application of targeted amino acid metabolomics identified abnormal absorption of amino acids as the underlying cause of decreased protein utilization during aging, particularly emphasizing a reduction in branched-chain amino acids (BCAAs) in older mice. Delving deeper into the proteomics of the intestinal protein digestion and absorption pathway, a reduction of over 60% in large neutral amino acid transporter 2 (LAT2) protein expression was observed in both older humans and aged mice. The reduction in LAT2 protein was found to be a key factor influencing the diminished BCAA availability. Overall, our study establishes the significance of amino acid absorption through LAT2 in protein utilization during aging and offers a new theoretical foundation for improving protein utilization in the older adults.

Investigation of pepsin levels in bronchial lavage in patients with interstitial lung disease and chronic cough

AimPepsin is an enzyme that helps digest protein secreted only from the gastric chief cell in an inactive state. Pepsin is a good marker for acidic gastroesophageal reflux (GER). Its presence in sputum or saliva is considered pathologic. In GER, cough is stimulated by broncho-esophageal neurogenic reflex and aspiration of gastric contents into the airways. GER is the most common cause of cough. Gastric acid reflux is also thought to play a role in Interstitial Lung Disease (ILD) etiology. In many studies, pepsin and bile acid levels in bronchial lavage were high in patients with interstitial lung disease and chronic cough. In our study, we aimed to evaluate pepsin levels in bronchial lavage in patients with ILD and chronic cough and to investigate the relationship between symptoms and reflux treatment. MethodsBetween January 2021 and February 2022, 212 patients who underwent bronchoscopy in our tertiary clinic were evaluated. These patients were divided into three groups: 52 patients with interstitial lung disease, 81 patients with chronic cough, and 79 patients who underwent bronchoscopy with a pre-diagnosis of lung cancer as the control group. Bronchial lavage obtained by bronchoscopy was analyzed for pepsin levels. ResultsShortness of breath and cough were the most common symptoms in all three groups. Pepsin levels were 16.71 ± 8.6 ng/ml in the chronic cough group, 15.6 ± 8.9 ng/ml in the ILD group, and 10.58 ± 5.4 ng/ml in the lung cancer (control) group. Pepsin levels in the ILD and chronic cough group were statistically significantly higher than in the lung cancer group (p:0.00). There was no statistical difference between the ILD group and the chronic cough group regarding pepsin levels. It was found that pepsin levels were lower in the three groups who received anti-reflux treatment. There was no difference in pepsin levels between ILD subgroups. ConclusionPepsin levels in bronchial lavage were higher in the ILD and chronic cough groups. This suggests that reflux may be involved in the etiology of chronic cough and ILD. Low pepsin values in patients receiving anti-reflux therapy have shown that occult reflux may occur. In our study, the high level of pepsin in bronchial lavage, especially in the chronic cough and ILD group, may be instructive in the etiology and treatment planning of the disease.

Effects of replacing fishmeal with Spirulina platensis powder on the Zig-zag eel (Mastacembelus armatus): Growth performance, flesh quality, digestibility, and gut microbial composition

Protein demand from aquaculture exacerbates environmental pressures. Zig-zag eel (Mastacembelus armatus, MA) is a new aquaculture species in southern China and has great potential for future promotion. In this study, we used Spirulina platensis powder (SPP) to replace 0–20 % of fishmeal in the feed, respectively. A 10-week aquaculture experiment was conducted on 600 MAs with five groups of F0 (0 %), F1 (5 %), F2 (10 %), F3 (15 %), and F4 (20 %) set up with equal nitrogen (approximately 50.00 % crude protein) and equal fat (about 5.50 % crude fat) feeds. The experimental results showed that replacing fishmeal with different proportions of SPP significantly reduced FCR (p < 0.05), increased WGR and SGR (p < 0.05), and reduced the feeding cost, with the best performance in F2. Polynomial analysis combining WGR and SGR showed that the optimum percentage of substitution was 10.93 % and 11.09 % in MA diets, respectively. The addition of SPP significantly reduced the levels of EPA and DHA content (p < 0.05), significantly increased the proportion of C14:0, C16:1, C20:5n3, and C22:6n3 (p < 0.05), and a high proportion of SPP addition significantly decreased saturated fatty acid content (p < 0.05). The length of intestinal villi and the secretion levels of Chymotrypsin and Pepsin were significantly increased (p < 0.05), and the secretion level of Lipase was significantly decreased (p < 0.05) in the experimental group. A low percentage of SPP increased microbial diversity in MA’s gut. Functional pathways related to metabolic functions were the most obvious broad groups with the most significant changes in relative abundance in the experimental group, and Plesiomonas and Aeromonas may be the key microorganisms involved in regulating the digestion and metabolism of SPP in the gut of MA.

Does Extraesophageal Reflux Support the Development of Lung Adenocarcinoma? Analysis of Pepsin in Bronchoalveolar Lavage in Non-Smoker Patients.

The significance of extraesophageal reflux as a risk factor in lung adenocarcinoma has been understudied. In this study, we investigated whether extraesophageal reflux leads to higher pepsin concentrations in bronchoalveolar lavage (BAL) in patients with lung adenocarcinoma compared to controls. Subjects were recruited from non-smoker patients (lifelong non-smokers and ex-smokers with more than 5 years of non-smoking history) who had undergone bronchoscopy due to pulmonary abnormalities on a CT scan and met the inclusion criteria. Based on histological verification of the lung process, the patients were divided into three groups: (1) lung adenocarcinoma, (2) pulmonary metastases, and (3) lung sarcoidosis. Lung adenocarcinoma cases were further categorized as central or peripheral. BAL samples collected during bronchoscopy were quantitatively analyzed by enzyme-linked immunosorbent assay (ELISA) to measure pepsin levels. No statistically significant difference in pepsin concentration was observed between the lung adenocarcinoma group and control groups (p = 0.135). After excluding hemorrhagic BAL samples, the pepsin concentration was significantly the lowest in patients with lung adenocarcinoma (p = 0.023) compared to the control groups. The results of the study do not support the hypothesis of a higher occurrence of extraesophageal reflux (evaluated as the amount of pepsin in BAL) in non-smoker patients with lung adenocarcinoma.

Enhanced modified poly-tyrosine voltammetric sensor for the quantification detection of salivary pepsin

Pepsin as an aspartic acid protease member and one of the three foremost proteolytic enzymes in the digestive system is essential to be detected. An electrochemically polymerized tyrosine film on carbon paste electrode (pTyr/CPE) has been synthesized by electro-polymerization donating an affordable electrochemical sensor to sense salivary pepsin as a diagnostic technique for gastroesophageal reflux disease (GRD) due to saliva collection is non-invasive and relatively comfortable. The pTyr/CPE was applied for Voltammetric sensing of pepsin and its quantification in phosphate buffer solution of pH 2.0 (PBS). Scanning electron microscopy (SEM) was conducted to learn the surface morphology. Cyclic voltammetry (CV), differential pulse voltammetry (DPVs), chronoamperometry (CA), and electrochemical impedance spectroscopy (EIS) were developed to realize the electrocatalytic activity of the sensor. The pTyr/CPE proceeded as a sensitive detector to pepsin with two linear ranges from 1 to 20 & 20 to 100 ng/mL donating two limits of detection as 0.5 & 0.09 ng/mL, respectively, and high selectivity toward pepsin, as well as stability and fast response of 1.5 s. Consequently, it is guessed that the pTyr/CPE sensor could be supportive for the initial diagnosis of GRD through the detection of pepsin in saliva. Finally, we quantified the pepsin levels in saliva samples of LPR patients (n = 2), showing that the results were agreeable with those from the electrochemical sensor.

A double-blind randomized clinical trial of inflammatory cytokine and pepsin levels in the saliva of patients with voice prostheses.

Tracheoesophageal speech is one of the most effective method used for voice rehabilitation after laryngectomy. The main limitation is the need for periodic voice prothesis (VP) replacements. The process of developing VP usage complications is still unexplored. The aim of this study was to assess the level of cytokines (IL-1β, IL-6, IL-8, IL-10, TNFα) and pepsin in saliva as potential factors reducing VP longevity. Prospective double-blind randomized clinical trial was conducted (NCT04268459). Patients were randomly divided into two groups depending on VP replacement regimen (regular-every 3 months, or irregular-when complications occur). Levels of IL-1β, IL-6, IL-8, IL-10, TNFα, and pepsin in saliva samples (fasting and after eating) of laryngectomized patients were measured using ELISA tests. Fifty-two patients (26 in both groups) with control group (7 patients) participated in the study. The level of IL-1β, IL-6, IL-8, IL-10, TNFα, and pepsin did not differ according to regularity of VP replacements (p = 0.301-0.801). IL-6 levels were significantly higher when VP complications occurs (p = 0.012). The saliva components were not significantly different depending on the frequency of VP replacements. IL-6 plays an important role in the development of VP use complications.

Research on the mechanism of Guanyu Zhixie Granule in intervening gastric ulcers in rats based on network pharmacology and multi-omics.

Guanyu Zhixie Granule (GYZXG) is a traditional Chinese medicine compound with definite efficacy in intervening in gastric ulcers (GUs). However, the effect mechanisms on GU are still unclear. This study aimed to explore its mechanism against GU based on amalgamated strategies. The comprehensive chemical characterization of the active compounds of GYZXG was conducted using UHPLC-Q/TOF-MS. Based on these results, key targets and action mechanisms were predicted through network pharmacology. GU was then induced in rats using anhydrous ethanol (1 mL/200 g). The intervention effects of GYZXG on GU were evaluated by measuring the inhibition rate of GU, conducting HE staining, and assessing the levels of IL-6, TNF-α, IL-10, IL-4, Pepsin (PP), and epidermal growth factor (EGF). Real-time quantitative PCR (RT-qPCR) was used to verify the mRNA levels of key targets and pathways. Metabolomics, combined with 16S rRNA sequencing, was used to investigate and confirm the action mechanism of GYZXG on GU. The correlation analysis between differential gut microbiota and differential metabolites was conducted using the spearman method. For the first time, the results showed that nine active ingredients and sixteen targets were confirmed to intervene in GU when using GYZXG. Compared with the model group, GYZXG was found to increase the ulcer inhibition rate in the GYZXG-M group (p < 0.05), reduce the levels of IL-6, TNF-α, PP in gastric tissue, and increase the levels of IL-10, IL-4, and EGF. GYZXG could intervene in GU by regulating serum metabolites such as Glycocholic acid, Epinephrine, Ascorbic acid, and Linoleic acid, and by influencing bile secretion, the HIF-1 signaling pathway, and adipocyte catabolism. Additionally, GYZXG could intervene in GU by altering the gut microbiota diversity and modulating the relative abundance of Bacteroidetes, Bacteroides, Verrucomicrobia, Akkermansia, and Ruminococcus. The differential gut microbiota was strongly associated with serum differential metabolites. KEGG enrichment analysis indicated a significant role of the HIF-1 signaling pathway in GYZXG's intervention on GU. The changes in metabolites within metabolic pathways and the alterations in RELA, HIF1A, and EGF mRNA levels in RT-qPCR experiments provide further confirmation of this result. GYZXG can intervene in GU induced by anhydrous ethanol in rats by regulating gut microbiota and metabolic disorders, providing a theoretical basis for its use in GU intervention.

THERAPEUTIC APPROACHES FOR ACID REDUCTION IN PATIENTS ADMITTED TO INTENSIVE CARE UNITS WITH A HISTORY OF GASTROESOPHAGEAL REFLUX DISEASE AT A TERTIARY CARE HOSPITAL IN PAKISTAN.

Introduction: Although the prevalence of gastroesophageal reflux disease (GERD) in intensive care units is still unknown, the condition is on the rise all over the world. Patients in critical condition are especially susceptible to gastroesophageal reflux disease (GERD) because of the many procedures and underlying illnesses they undergo. Pepsin levels in oral secretions, ambulatory monitoring, and pH measurement are among procedures that can be utilized in the diagnostic process. The most popular treatment methods consist of adjusting one's lifestyle and using medicine, mainly proton pump inhibitors (PPIs). Methodology: An analysis of data collected from 96 critically sick patients who were getting acid-lowering medication was carried out in retrospective research that was carried out at a tertiary care hospital in AJK, Pakistan between June and December 2023. Results: Most patients were being treated in medical intensive care units (MICU), and the medications that were prescribed the most frequently were omeprazole and esomeprazole. Omeprazole and antacids were the primary maintenance medications that were administered at the time of discharge. Patients who were diagnosed with gastroesophageal reflux disease (GERD) and those who were undergoing mechanical ventilation made up a sizeable share, with most of them receiving intravenous proton pump inhibitors (PPIs). Both potassium-competitive acid blockers and omeprazole were shown to have equivalent levels of treatment efficacy, according to the findings. Conclusion: Most of trials in past have established esomeprazole being highlighted as having superiority in certain studies. On the other hand, newer possibilities such as GABA-B agonist baclofen and P-CABs offer potential lines of investigation. Even though developing medicines require more exploration for routine management, intravenous proton pump inhibitors (PPIs) continue to be the primary emergency treatment for gastroesophageal reflux disease (GERD) in critical care.

Determination of pepsin in human saliva using pepsin-susceptible peptide reporter and colorimetric dipstick assay: a prospective, cross-sectional study.

A simple and effective pepsin detection assay is reported based on a pepsin-susceptible peptide (PSP) reporter degradation strategy. PSP, which can be specifically cleaved by pepsin, was modified with fluorescein isothiocyanate (FITC) and biotin at the N- and C-terminals to be used as a reporter for colorimetric detection of dipsticks. A universal lateral flow dipstick consisting of a streptavidin test line for biotin binding and a sample pad immobilized with a gold-labeled polyclonal (rabbit) anti-FITC antibody was used to verify PSP-based pepsin detection. When the PSP reporter reacts with pepsin in a tube, it cleaves into two fragments, and the cleaved fragments do not display any color on the test line. Therefore, the higher the concentration of pepsin is, the greater is the decrease in test line intensity (IT-line) and the higher is the control line intensity (IC-line). First, the PSP cleavage and dipstick assay conditions for pepsin detection was optimized. The ratio of color intensity (IT-line/IC-line) of PSP-based dipstick assay showed a linear relationship with log concentration of pepsin ranging between 4 and 500 ng/mL (R2 = 0.98, n = 6), with a limit of detection of 1.4 ng/mL. It also exhibited high specificity and good reproducibility. Finally, pepsin levels were quantified in saliva samples from healthy controls (n = 34) and patients with laryngopharyngeal reflux (LPR, n = 61). Salivary pepsin levels were higher in patients with LPR than in healthy controls. The salivary pepsin levels correlated with those measured using a conventional enzyme-linked immunosorbent assay kit. Therefore, this PSP-based dipstick assay is a convenient tool for assessing salivary pepsin levels.

Gambaran Kadar Pepsin pada Saliva Pasien Refluks Laringofaring di RSUP Dr. M. Djamil Padang

Laryngopharyngeal reflux (RFL) is a condition of tissue inflammation in the upper aerodigestive tract due to the reflux of gastric and duodenal contents, the symptoms such as post-nasal drip, globus sensation, and heartburn which decrease quality of life. RFL was diagnosed subjectively using the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). The pepsin levels in saliva that were detected by ELISA can be a sensitive and objective diagnostic marker for RFL because pepsin was only produced by chief cells in the stomach. The purpose of this study was to determine the characteristics of RFL patients based on age, sex, features of complaints in RSI, features of anatomic abnormalities in RFS, and salivary pepsin levels.&#x0D; This study was a descriptive observational retrospective design. From September to October 2022, this study was carried out at the Medical Record Department of RSUP Dr. M. Djamil Padang. The Lemeshow formula was used as the minimum number sampling in this study, 22% was the value of the proportion of events. &#x0D; The findings of this study revealed that 20 patients with RFL were tested for pepsin levels in saliva at Dr. RSUP. M. Djamil Padang, with nearly the same total number of RFL patients in each age group. The majority of RFL patients (60.0%) were female, and the most common complaint felt by RFL sufferers was post-nasal drip (90.00%). The most common anatomic abnormality was diffuse laryngeal edema (100%), and the mean pepsin levels in saliva was 15.863 ng/mL. Pepsin was found in all samples.&#x0D; Keywords: laringofaringeal reflux, pepsin, saliva

Predicting ventilator-associated pneumonia in elderly patients requiring mechanical ventilation through the detection in tracheal aspirates

ABSTRACT Objective In this study, we evaluated the clinical utility of tracheal aspirates α-amylase (AM), pepsin, and lipid-laden macrophage index (LLMI) in the early diagnosis of ventilator-associated pneumonia (VAP) in elderly patients on mechanical ventilation. Methods Within 96 hours of tracheal intubation, tracheal aspirate specimens were collected from elderly patients on mechanical ventilation; AM, pepsin, and LLMI were detected, and we analyzed the potential of each index individually and in combination in diagnosing VAP. Results Patients with VAP had significantly higher levels of AM, pepsin, and LLMI compared to those without VAP (P < 0.001), and there was a positive correlation between the number of pre-intubation risk factors of aspiration and the detection value of each index in patients with VAP (P < 0.001). The area under a receiver operating characteristic (ROC) curve (AUC) of AM, pepsin, and LLMI in diagnosis of VAP were 0.821 (95% CI:0.713–0.904), 0.802 (95% CI:0.693–0.892), and 0.621 (95% CI:0.583–0.824), the sensitivities were 0.8815, 0.7632, and 0.6973, the specificities were 0.8495, 0.8602, and 0.6291, and the cutoff values were 4,321.5 U/L, 126.61 ng/ml, and 173.5, respectively. The AUC for the combination of indexes in diagnosing VAP was 0.905 (95% CI:0.812–0.934), and the sensitivity and specificity were 0.9211 and 0.9332, respectively. In the tracheal aspirate specimens, the detection rate of AM ≥ cutoff was the highest, while it was the lowest for LLMI (P < 0.001). The detection rates of AM ≥ cutoff and pepsin ≥ cutoff were higher within 48 hours after intubation than within 48–96 hours after intubation (P < 0.001). In contrast, the detection rate of LLMI ≥ cutoff was higher within 48–96 hours after intubation than within 48 hours after intubation (P < 0.001). The risk factors for VAP identified using logistic multivariate analysis included pre-intubation aspiration risk factors (≥3), MDR bacteria growth in tracheal aspirates, and tracheal aspirate AM ≥ 4,321.5 U/L, pepsin ≥ 126.61 ng/ml, and LLMI ≥ 173.5. Conclusion The detection of AM, pepsin, and LLMI in tracheal aspirates has promising clinical utility as an early warning biomarker of VAP in elderly patients undergoing mechanical ventilation.

Usefulness of pepsin saliva measurement for the detection of primary burning mouth syndrome related to reflux.

To study the diagnostic value of salivary pepsin tests for detecting laryngopharyngeal reflux (LPR) in patients with primary burning mouth syndrome (BMS). Patients with BMS and asymptomatic individuals were consecutively recruited from September 2018 to June 2023. Patients underwent hypopharyngeal-esophageal impedance pH-monitoring (HEMII-pH) and saliva collections to measure pepsin. Stomatology evaluation was carried out to exclude other causes of BMS. Oral, pharyngeal and laryngeal signs and symptoms were evaluated with Reflux Sign Assessment (RSA) and Reflux Symptom Score (RSS). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of pepsin test were calculated considering the highest values of pepsin tests at ≥ 16, ≥ 36, and ≥ 100ng/mL cutoffs. Receiver operating characteristic curve (ROC) was evaluated. Forty-nine patients with both BMS and LPR at the HEMII-pH and 21 asymptomatic individuals were recruited. Pepsin test was 83.7%, 79.6%, and 71.4% sensitive at cutoffs ≥ 16, ≥ 36, and ≥ 100ng/mL, respectively. The ROC analysis reported that a threshold of ≥ 21.5ng/mL was associated with sensitivity, specificity, PPV and NPV of 81.6%, 81.0%, 90.1% and 65.4%, respectively. The severity score of burning mouth symptom was significantly associated with the saliva pepsin concentration (rs = 0.263; p = 0.029) and the oral RSA (rs = 0.474; p = 0.007). Pepsin test is a valuable diagnostic approach for detecting LPR in patients with BMS. Patients with high level of saliva pepsin reported more severe burning mouth symptoms. Future studies are needed to confirm the role of LPR in the primary BMS.

A prospective study of extraesophageal reflux and potential microaspiration in patients hospitalized with COVID-19 in Jordan

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lung infection has represented a global challenge. Intriguingly, it has been shown that the alveolar lung epithelium expresses little Angiotensin Converting Enzyme receptor protein (ACE2), the entry receptor for SARS-CoV-2. Upper airway establishment of infection and translocation to the lung is well documented but other anatomical niches may be relevant to potentially serious lung infection. ACE2 is heavily expressed in the gastrointestinal tract and gastrointestinal symptoms support a clinical diagnosis of Coronavirus disease 2019 (COVID-19). This suggests a research question and the need to gather patient data exploring potential aerodigestive links in SARS-CoV-2 tranlocation and infection which may be relevant in the peripheral lung. This recognizes anatomical proximity and concepts of bi-directional movement between the Gastrointestinal and lung systems in normal physiology and disease. We have therefore explored the potential for gastro oesophageal reflux disease (GORD) micro aspiration and aeorodigestive pathophysiology in a novel prospective investigation of patients hospitalized with COVID-19.MethodsThis is a prospective descriptive cohort study of 210 patients who were hospitalized with a confirmed diagnosis of COVID-19. The cohort was divided into three groups of patients based on symptom severity and radiological results. The Reflux Symptom Index (RSI) was used to evaluate the presence and severity of GOR. An RSI greater than 13 is considered to be abnormal. Patients’ saliva samples were tested using enzyme-linked immunosorbent assay (ELISA) to determine the level of salivary pepsin among the cohort of patients.ResultsA total of 210 patients with COVID-19 were enrolled in the study with 55.2% (116/210) classified as mildly ill, 31.9% (67/210) moderately ill and 12.9% (27/210) as severely ill. 34% (72/210) of the patients had an RSI score of over 13 and a median salivary pepsin value of 54 ± 29 ng/ml which suggested an incidence of extraesophageal reflux (EOR) in around a third of patients. The presence of respiratory comorbid conditions, an RSI score of over 13 and a salivary pepsin level of > 76ng/ml increased the risk of developing a more severe COVID-19 infection.ConclusionThe study showed a high prevalence of EOR among the study cohort and provide the first prospective evidence suggesting the potential for aerodigestive pathophysiology including microaspiration in COVID-19 disease. We believe that the results of our study support the need for more extensive research.

Clinical Utility of Pepsin and Bile Acid in Tracheal Secretions for Accurate Diagnosis of Aspiration in ICU Patients.

Aspiration of stomach content or saliva in critical conditions-e.g., shock, intoxication, or resuscitation-can lead to acute lung injury. While various biomarkers in bronchoalveolar lavage fluids have been studied for diagnosing aspiration, none have been conclusively established as early indicators of lung damage. This study aims to evaluate the diagnostic value of pepsin, bile acid, and other biomarkers for detecting aspiration in an intensive care unit (ICU). In this study, 50 ICU patients were enrolled and underwent intubation before admission. The evaluation of aspiration was based on clinical suspicion or documented instances of observed events. Tracheal secretion (TS) samples were collected within 6 h after intubation using sterile suction catheters. Additional parameters, including IL-6, pepsin, and bile acid, were determined for analysis. Pepsin levels were measured with an ELISA kit, while bile acid, uric acid, glucose, IL-6, and pH value in the tracheal secretion were analyzed using standardized lab methods. The 50 patients admitted to the ICU with various diagnoses. The median survival time for the entire cohort was 52 days, and there was no significant difference in survival between patients with aspiration pneumonia (AP) and those with other diagnoses (p = 0.69). Among the AP group, the average survival time was 50.51 days (±8.1 SD; 95% CI 34.63-66.39), while patients with other diagnoses had a mean survival time of 32.86 days (±5.1 SD; 95% CI 22.9-42.81); the survival group comparison did not yield statistically significant results. The presence of pepsin or bile acid in TS patients did not significantly impact survival or the diagnosis of aspiration. The p-values for the correlations between pepsin and bile acid with the aspiration diagnosis were p = 0.53 and p > 0.99, respectively; thus, pepsin and bile acid measurements did not significantly affect survival outcomes or enhance the accuracy of diagnosing aspiration pneumonia. The early and accurate diagnosis of aspiration is crucial for optimal patient care. However, based on this study, pepsin concentration alone may not reliably indicate aspiration, and bile acid levels also show limited association with the diagnosis. Further validation studies are needed to assess the clinical usefulness and reliability of gastric biomarkers in diagnosing aspiration-related conditions. Such future studies would provide valuable insights for improving aspiration diagnosis and enhancing patient care.

Diagnostic Value of Pepsin Measurements in Dysphonia Attributed to Laryngopharyngeal Reflux Disease

To investigate the diagnostic value of pepsin test in detecting laryngopharyngeal reflux (LPR) in patients with suspected LPR-induced dysphonia. Dysphonic and non-dysphonic patients with LPR at the 24-hour hypopharyngeal-esophageal impedance-pH monitoring (HEMII-pH) were recruited from January 2019 to November 2022. Patients collected saliva/sputum samples to measure pepsin concentrations. Symptoms and findings were studied through reflux symptom score (RSS) and reflux sign assessment (RSA). Voice quality was assessed with maximum phonation time, GRBAS, voice handicap index (VHI), and acoustic parameters at baseline and 3-month post-treatment. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of pepsin tests for dysphonia-related to LPR were calculated at ≥16ng/mL cutoff. The relationship between HEMII-pH, clinical features, voice quality outcomes, and pepsin measurement was investigated. Sixty-seven patients with LPR at the HEMII-pH completed the evaluations accounting for 30 patients consulting for dysphonia. Dysphonic patients reported higher RSS than non-dysphonic patients. RSS, RSA, laryngeal findings, VHI, and grade of dysphonia significantly improved from baseline to 3-month posttreatment. Pepsin test detected LPR in 73% of dysphonic cases. The pepsin test was 73.3 sensitive and 18.9 specific when considering the highest pepsin level of morning, postlunch, and postdinner sputum collections. Sensitivity, specificity, PPV, and NPV varied regarding the time of sputum collections. There was a strong significant association between the concentration of the morning pepsin test and the severity of laryngeal RSA score (P=0.018). The morning pepsin saliva test concentration was predictive of the 3-month otolaryngological RSS (P=0.014). Pepsin test is a sensitive but poorly specific diagnostic approach for patients with dysphonia attributed to LPR. Multiple pepsin measurements may increase the sensitivity and predictive value of pepsin test. Future large-cohort studies are needed to investigate the accuracy of pepsin test in this population.

Effects of Different Feeding Regimes on Growth Performance, Survival Rate, Carcass Composition, Fatty Acids Profile, and Digestive Enzyme Activities of Great Sturgeon (Huso huso Linnaeus, 1758) Larvae

Six different feeding regimes (FR) were tested from 7 to 38 days post hatching (dph). Five thousand four hundred larvae (7 dph, 0.048 g) were randomly stocked in 18 fiberglass tanks contained 100 L fresh water (300 larvae per each tank). In larvae fed with FR-B, includes Artemia nauplii (AN) + Artemia biomass (AB) + microdiet (MD), the body weight (BW) at the end of trail (38 dph) similar the FR-D (AN + CHL + AB + MD), and E (AN + CHL + AB), was at high level. Survival rate was higher in larvae fed FR-A includes AN + chironomid larvae (CHL) + MD, but had a lower BW ( p &lt; 0.05 ). Moderate BW and survival rate were detected in larvae fed FR-C (AN + DP + MD). Larvae fed only MD (FR-F), had the lowest survival and the highest BW ( p &lt; 0.05 ). Different FR had a significant effect on crude protein (CP), crude fat (CF), ash, and dry weight ( p &lt; 0.05 ). The larvae fed FR-C and D had the highest CP ( p &lt; 0.05 ). The highest CF and ash in larvae were detected in FR-F and C, respectively ( p &lt; 0.05 ). Larvae from FR-A and B had higher levels of n−3 long chain polyunsaturated fatty acids in comparison with others FR ( p &lt; 0.05 ). The use of AB and CHL can increased the weight and survival rate of larvae, respectively. At the end of trail, the activity of pepsin, trypsin, lipase and α-amylase enzyme levels were lower in FR-B and F than others FR. Totally, by using a combination of AN + CHL + AB + MD had better results than others and ordered to H. huso larvae feeding. Using MD alone, can cause lesser development of the digestive system and little attractiveness, therefore it can cause starvation, and the empty digestive tract of larvae.

Effects of dietary guava leaf aqueous extract supplementation on growth, antioxidant capacity, and non-specific immunity in mud crab Scylla paramamosain

Mud crab (Scylla paramamosain) fed five different diets with varying concentrations of guava leaf aqueous extract (0 mg·kg–1, 80 mg·kg–1, 160 mg·kg–1, 320 mg·kg–1, and 640 mg·kg–1) for 30 days. Mud crabs in the 320 mg·kg–1 guava-leaf extract groups outperformed the control group in terms of survival rates (SR), weight gain rates (WGR), and specific growth rates (SGR). When compared to the control group, mud crabs in the 320 mg·kg–1 guava-leaf extract groups had significantly higher levels of lipase (LPS), pepsin, lysozyme (LZM), superoxide dismutase (SOD), acid phosphatase (ACP), and glutathione (GSH) (P &lt; 0.05). The amylase (AMS) activity was significantly decreased in all experimental groups (P &lt; 0.05). Malondialdehyde (MDA) content in the hepatopancreas of mud crabs in the 160 mg·kg–1, 320 mg·kg–1, and 640 mg·kg–1 guava-leaf extract groups were significantly reduced compared to the control group (P &lt; 0.05). Additionally, real-time PCR results illustrated that the expression levels of GPx3, CAT, and JNK were all considerably increased in the 80 mg·kg–1 guava-leaf extract groups compared to the control group (P &lt; 0.05). In the 160 mg·kg–1, 320 mg·kg–1, and 320 mg·kg–1 guava-leaf extract groups, the expression levels of SOD genes were considerably greater than the control (P &lt; 0.05), which was consistent with the level of SOD activity. GST and P53 gene expression levels were significantly up-regulated in the 80 mg·kg–1, 160 mg·kg–1, 320 mg·kg–1, and 640 mg·kg–1 guava-leaf extract groups compared to the control group (P &lt; 0.05). Overall, the addition of 160 mg·kg–1-320 mg·kg–1 guava-leaf extract to the feed of Scylla paramamosain promoted growth, enhanced the activities of digestive and antioxidant enzymes, and strengthened immunity.

Pepsin Increases the Proliferation of Vocal Cord Leukoplakia Epithelial Cells by Inducing Autophagy.

To investigate the role of H+ /K+ ATPase in the proliferation of pepsin-induced vocal cord leukoplakia (VCL) cells. Translation research. Affiliated Hospital of University. Immunohistochemistry was used to detect pepsin, H+ /K+ ATPase (ATP4A and ATP4B subunits) in VCL cells with varying degrees of dysplasia. After primary cultures of VCL cells had been established, the effects of acidified pepsin on the proliferation, autophagy, and H+ /K+ -ATPase distribution of VCL cells were investigated. The levels of pepsin, ATP4A, and ATP4B were significantly higher in VCL tissue with moderate-to-severe dysplasia than in normal tissue (p < .05); these levels gradually increased according to dysplasia severity. The expression levels of ATP4A and ATP4B were significantly correlated with the amount of pepsin in VCL cells (p < .01). Acidified pepsin enhanced the levels of proliferation and autophagy in human VCL epithelial cells. The cloning- and autophagy-promoting effects of acidified pepsin on VCL cells were partially reversed by pantoprazole; these effects were completely blocked by the autophagy inhibitor chloroquine. Finally, acidified pepsin promoted the colocalization of H+ /K+ -ATPase and lysosomes in VCL cells; it also mediated lysosome acidification. Pepsin and H+ /K+ -ATPase may contribute to the progression of VCL. Specifically, acidified pepsin may regulate lysosome acidification by promoting lysosomal localization of H+ /K+ -ATPase.