title: Extra-Esophageal Pepsin from Stomach Refluxate Promoted Tonsil Hypertrophy.
abstract: BACKGROUND
  Gastroesophageal reflux is associated with numerous pathologic conditions of the upper aerodigestive tract. Gastric pepsin within reflux contributes to immunologic reactions in the tonsil. In this study, we aimed to find the relationships between pepsin and tonsillar hypertrophy.
  
  
  RESULTS
  We explored the notion whether tonsillar hypertrophy was due to pepsin-mediated gastric reflux in tonsil hypertrophy. Fifty-four children with tonsil hypertrophy and 30 adults with tonsillitis were recruited before surgical treatment. Blood and tonsil tissues from each patient were harvested for analysis of changes in lymphocyte and macrophage numbers coupled with histological and biochemical analysis. Pepsin was expressed at different levels in tonsil tissues from each tonsillar hypertrophy. Pepsin-positive cells were found in the crypt epithelium, surrounding the lymphoid follicle with developing fibrosis, and also surrounding the lymphoid follicle that faced the crypt. And also, pepsin staining was well correlated with damaged tonsillar squamous epithelium and TGF-β1 and iNOS expression in the tonsil section. In addition, pepsin and TGF-β1-positive cells were co-localized with CD68-positive cells in the crypt and surrounding germinal centers. In comparison of macrophage responsiveness to pepsin, peripheral blood mononuclear cells (PBMNCs) were noticeably larger in the presence of activated pepsin in the child group. Furthermore, CD11c and CD163-positive cells were significantly increased by activated pepsin. However, this was not seen for the culture of PBMNCs from the adult group.
  
  
  CONCLUSIONS
  The lymphocytes and monocytes are in a highly proliferative state in the tonsillar hypertrophy and associated with increased expression of pro-inflammatory factors as a result of exposure to stomach reflux pepsin.
authors.affiliation: Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea.
authors.forename: Jin Hyun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
authors.forename: Han-Sin
authors.initials: HS
authors.lastname: Jeong
authors.affiliation: Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea.
authors.forename: Kyung Mi
authors.initials: KM
authors.lastname: Kim
authors.affiliation: Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea.
authors.forename: Ye Jin
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea.
authors.forename: Myeong Hee
authors.initials: MH
authors.lastname: Jung
authors.affiliation: Department of Otolaryngology, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea.
authors.forename: Jung Je
authors.initials: JJ
authors.lastname: Park
authors.affiliation: Department of Otolaryngology, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea.
authors.forename: Jin Pyeong
authors.initials: JP
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea.|Institute of Health Sciences, Gyeongsang National University Hospital, Jinju, Gyeongsangnamdo, Korea.
authors.forename: Seung Hoon
authors.initials: SH
authors.lastname: Woo
mesh_terms: D000328:Adult; D015153:Blotting, Western; D002465:Cell Movement; D002470:Cell Survival; D002478:Cells, Cultured; D002648:Child; D002675:Child, Preschool; D005260:Female; D005455:Fluorescent Antibody Technique; D005765:Gastrointestinal Agents / Q000494:pharmacology; D006801:Humans; D006984:Hypertrophy / Q000139:chemically induced / Q000473:pathology*; D007124:Immunoenzyme Techniques; D047468:Immunoprecipitation; D008264:Macrophages / Q000187:drug effects / Q000473:pathology*; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology*; D010434:Pepsin A / Q000494:pharmacology*; D012333:RNA, Messenger / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013270:Stomach / Q000187:drug effects / Q000473:pathology*; D014069:Tonsillitis / Q000139:chemically induced / Q000473:pathology*
chemical_list: D005765:Gastrointestinal Agents; D012333:RNA, Messenger; D010434:Pepsin A