endothelin-1 and Gastroesophageal-Reflux

Patients with preeclampsia display elevated placenta-derived sFlt-1 (soluble Fms-like tyrosine kinase-1) and endoglin levels and decreased placental growth factor levels. Proton pump inhibitors (PPIs) decrease trophoblast sFlt-1 and endoglin secretion in vitro. PPIs are used during pregnancy to combat reflux disease. Here, we investigated whether PPIs affect sFlt-1 in women with confirmed/suspected preeclampsia, making use of a prospective cohort study involving 430 women. Of these women, 40 took PPIs (6 esomeprazole, 32 omeprazole, and 2 pantoprazole) for 8 to 45 (median 29) days before sFlt-1 measurement. Measurements were only made once, at study entry between weeks 20 and 41 (median 33 weeks). PPI use was associated with lower sFlt-1 levels, with no change in placental growth factor levels, both when compared with all non-PPI users and with 80 gestational age-matched controls selected from the non-PPI users. No sFlt-1/placental growth factor alterations were observed in women using ferrous fumarate or macrogol while, as expected, women using antihypertensive medication displayed higher sFlt-1 levels and lower placental growth factor levels. The PPI use-associated decrease in sFlt-1 was independent of the application of antihypertensive drugs and also occurred when restricting our analysis to patients with hypertensive disease of pregnancy at study entry. PPI users displayed more cases with preexisting proteinuria, less gestational hypertension, and a lower number of neonatal sepsis cases. Finally, their plasma endoglin and endothelin-1 levels were lower while sFlt-1 levels correlated positively with both. In conclusion, PPI use associates with low sFlt-1, endoglin, and endothelin-1 levels, warranting prospective trials to investigate the therapeutic potential of PPIs in preeclampsia.

Topics: Adult; Blood Pressure Determination; Cohort Studies; Endoglin; Endothelin-1; Female; Gastroesophageal Reflux; Gestational Age; Humans; Netherlands; Placental Function Tests; Pre-Eclampsia; Pregnancy; Prospective Studies; Proton Pump Inhibitors; Vascular Endothelial Growth Factor Receptor-1

Four hundred patients with bronchial asthma (BA) were questioned. Complex clinical and instrumental examination of 60 patients with BA and endoscopic-positive gastroesophageal reflux disease was carried out; the control groups included 30 patients with BA alone and 30 patients with GERD alone. Clinical symptoms of GERD were revealed in 58% of BA patients; endoscopic-positive GERD was diagnosed in 48.6% of BA patients. The study proved the connection between the degree of respiratory disturbances, on the one hand, and the degree of esophagitis and the level of intraesophageal pH, on the other, in patients with BA plus GERD. The study also established the role of esophageal and gastric epitheliocytes, producing endothelin-1, melatonin, NO-synthase, and calretinin, in the occurrence of mutual exacerbation syndrome.

Topics: Adult; Algorithms; Asthma; Calbindin 2; Endothelin-1; Esophagus; Female; Gastroesophageal Reflux; Humans; Male; Melatonin; Nitric Oxide Synthase; S100 Calcium Binding Protein G; Severity of Illness Index; Stomach