title: Role of reflux-induced epithelial-mesenchymal transition in periprosthetic leakage after prosthetic voice rehabilitation.
abstract: BACKGROUND
  Gastroesophageal reflux (GER) contributes to periprosthetic leakage after prosthetic voice rehabilitation. However, underlying mechanisms are unclear, and markers predicting anti-reflux therapy response are missing.
  
  
  METHODS
  We assessed epithelial-mesenchymal transition in 148 consecutive biopsies from 44 patients with/without fistula enlargement under dual-probe pH monitoring before and after proton-pump inhibitor (PPI) therapy applying immunohistochemistry. Results were correlated with reflux intensity and clinical and histologic findings.
  
  
  RESULTS
  Epithelial-mesenchymal transition correlated with GER in all samples, and patients with fistula enlargement showed higher epithelial-mesenchymal transition scores. Contrary to patients without enlargement, epithelial-mesenchymal transition scores did not regress during therapy in this group. Furthermore, pretherapeutic epithelial-mesenchymal transition scores were lower in therapy responders than in nonresponders without reaching significance (p = .07).
  
  
  CONCLUSIONS
  We demonstrate that epithelial-mesenchymal transition correlates with severity of GER and presence of periprosthetic fistula enlargement in patients who underwent prosthetic voice rehabilitation, but epithelial-mesenchymal transition seems to be reversible upon PPI treatment in early stages only.
authors: Department of Otorhinolaryngology - Head and Neck Surgery, Bundeswehrkrankenhaus Ulm, Ulm, Germany.
authors: Kai J
authors: KJ
authors: Lorenz
authors: Klaus
authors: K
authors: Kraft
authors: Franziska
authors: F
authors: Graf
authors: Christian
authors: C
authors: Pröpper
authors: Konrad
authors: K
authors: Steinestel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058750:Epithelial-Mesenchymal Transition; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007150:Immunohistochemistry; D007831:Larynx, Artificial; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D014138:Tracheoesophageal Fistula / Q000150:complications
chemical_list: D054328:Proton Pump Inhibitors
keywords: epithelial-mesenchymal transition; fistula; gastroesophageal reflux; vimentin; voice prosthesis