Associations of Circulating Gut Hormone and Adipocytokine Levels with the Spectrum of Gastroesophageal Reflux Disease.
OBJECTIVE
The pathogenesis of gastroesophageal reflux disease (GERD) is complex and poorly understood. We aim to investigate the association of various circulating peptide hormones with heterogenous manifestations of GERD.


METHODS
One hundred and four patients that had experienced typical GERD symptoms (heartburn and/or acid regurgitation) for at least 3 episodes per week in the past 3 months were enrolled. All patients received a baseline assessment of symptom severity and frequency with the Reflux Disease Questionnaire and an upper endoscopy to classify GERD into erosive esophagitis (EE, n = 67), non-erosive esophagitis (NE, n = 37), and Barrett's esophagus (BE, n = 8). Fifty asymptomatic subjects with an endoscopically normal esophagus were recruited as the control group. Complete anthropometric measures and blood biochemistry were obtained and fasting serum levels of adipocytokines (adiponectin and leptin) and gut hormones (ghrelin and peptide YY (PYY)) were determined by enzyme-linked immunosorbent assay in all subjects.


RESULTS
All circulating peptide hormone levels were not statistically different between the GERD and control groups. However, GERD patients appeared to have lower PYY levels [median (25th-75th percentile), 80.1 (49.8-108.3) vs. 99.4 (65.8-131.9) pg/ml, p = 0.057] compared with control subjects. Among the GERD patients, ghrelin levels were inversely associated with the frequency and severity of acid regurgitation. In male GERD patients, EE was associated with significantly higher PYY levels [107.0 (55.0-120.8) vs. 32.8 (28.7-84.5) pg/ml, p = 0.026] but lower adiponectin levels [6.7 (5.6-9.3) vs. 9.9 (9.6-10.6) μg/ml, p = 0.034] than NE. Patients with BE had significantly lower adiponectin levels [6.0 (5.1-9.2) vs. 9.2 (7.1-11.2) μg/ml, p = 0.026] than those without BE.


CONCLUSIONS
Humoral derangement of circulating peptide hormones might participate in inflammation and symptom perception in patients suffering from GERD. Further studies to clarify the exact role of these hormones in the pathogenesis of GERD are warranted.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Ping-Huei
PH
Tseng
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.
Wei-Shiung
WS
Yang
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Jyh-Ming
JM
Liou
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Yi-Chia
YC
Lee
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hsiu-Po
HP
Wang
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan.
Jaw-Town
JT
Lin
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ming-Shiang
MS
Wu
D052242:Adiponectin / Q000097:blood / Q000235:genetics*; D000328:Adult; D001471:Barrett Esophagus / Q000097:blood / Q000235:genetics* / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000097:blood / Q000235:genetics* / Q000473:pathology; D054439:Ghrelin / Q000097:blood / Q000235:genetics*; D006356:Heartburn / Q000473:pathology; D006801:Humans; D020738:Leptin / Q000097:blood / Q000235:genetics; D008297:Male; D008875:Middle Aged; D019894:Peptide YY / Q000097:blood / Q000235:genetics*; D011795:Surveys and Questionnaires
D052242:Adiponectin; D054439:Ghrelin; D020738:Leptin; D019894:Peptide YY