The Expression Of HO/CO System And NOS/NO System In The Patient's Mucous Membrane Of Esophagus Of Reflux Esophagitis

Objective: Reflux esophagitis(RE) is a disease that caused by the reflux of the mixed material in stomach and duodenum which manifests a serial of chronic symptoms and characterized pathologically by damage of membrane of esophagus. It is a kind of chronic disease which has a high incidence and is apt to relapse, and sometimes leading to severe complications .It has been greatly increased over the past several decades, but the etiology and pathogenesis of RE remains unclear, which influenced the diagnosis of them to some degree. Gaseous messenger mediator such as carbon monoxide(CO) and nitric oxide(NO) are supposed to be involved in the formation of RE according to the latest research. In this study, the lower esophageal sphincter pressure were detected by perfusion catheter manometer; the concentration of NO in serum were measured by nitrate reduction enzymic method; the concentrations of CO in the serum were determined with chemical methods; the distribution of HO-1,HO-2,iNOS,nNOS proteins in the patient's mucous membrane of esophagus of reflux esophagitis were detected by SP immunohistochemistry. In this study, the change of HO/CO System and NOS/NO System in the patient with RE were investigated, aim at finding out the role gaseous messenger mediator such as CO and NO in the pathogenesis of RE.Methods:77 cases with RE were divided into four groups according to endoscopic finding (Los Angeles grading system): grade A,grade B,grade C,graded D; 20 cases presenting with a normal esophagus were served as the normal control group. The lower esophageal sphincter pressure were detected by perfusion catheter manometer. The concentration of NO in serum by nitrate reduction enzymic method.The concentrations of CO in the serum were determined with chemical methods. The distribution of HO-1,HO-2,iNOS,nNOS proteins in the patient's mucous membrane of esophagus of reflux esophagitis were detected by SP immunohistochemistry, The slides were then analyzed with an Image Analyzing System to obtain the mean optical density(OD) of stained proteins. The SPSS11.0 statistic software package for Windows was used to perform the analysis.Results:(1)The lower esophageal sphincter pressure( mmHg) in the normal control group, grade A,grade B,grade C,grade D were 17.88±8.33,10.77±2.53,9.60±1.95,6.98±1.77,5.60±1.51 respectively . The lower esophageal sphincter pressure in the patients with RE were significantly lower than control group.(2)NO concentration in the normal control group, grade A,grade B,grade C,graded D were 49.24±18.57,58.22±21.69,62.40±24.07,73.74±37.30,94.51±36.19μmol/L respectively. The concentrations in patients between RE groups and normal control group were significant; iNOS and nNOS were expressed mainly in the patient's esophagus mucous membrane epithelia with RE. The OD of the stained iNOS protein in the normal control group, grade A,grade B,grade C,graded D were 0.162±0.017,0.212±0.021,0.212±0.023,0.285±0.022,0.333±0.029 respectively;The OD values in iNOS was significantly higher than that in the normal control group. The OD of the stained nNOS protein in the normal control group, grade A,grade B,grade C,graded D were 0.175±0.013,0.200±0.028,0.205±0.036,0.214±0.039,0.217±0.063 respectively ; .It indicated that there were significantly higher than that in the normal control group. (3)CO concentration in the normal control group, grade A,grade B,grade C,grade D were 0.858±0.235,0.787±0.262,0.879±0.261,0.759±0.204, 0.810±0.287μmol/L respectively. The concentrations in patients between RE groups and normal control group were no difference;H0-1 was expressed mainly in the patient's esophagus mucous membrane epithelia with RE, the OD of the stained HO-1 protein in the normal control group, grade A,grade B,grade C,graded D were 0.176±0.016,0.209±0.031,0.210±0.032,0.238±0.032,0.312±0.050 respectively;The OD values in HO-1 was significantly higher than that in the normal control group. H0-2 was expressed mainly in the patient's esophagus mucous membrane epithelia in all groups, the OD of the stained HO-2 protein in the normal control group, grade A,grade B,grade C,graded D were 0.218±0.037,0.243±0.053,0.218±0.043,0.225±0.042,0.217±0.041 respectively. It indicated that there were not difference between RE groups and the normal control group. (4) The expression of HO-1 was positively correlated with iNOS expression in the esophagus mucous membrane epithelia in RE. It indicated that there were not difference in the normal control group.Conclusion: 1.The lower esophageal sphincter pressure in the patients with RE were significantly lower than that in the normal control group. It suggests that the patients with RE may have lower LES pressure. 2. iNOS and nNOS were mainly expressed in the esophagus mucous membrane epithelia in RE. The concentration of NO in RE was significantly higher than that in the normal control group. iNOS and nNOS may damage the patient's esophagus mucous under pathological condition.3. HO-1 was expressed mainly in the esophagus mucous membrane epithelia in RE. HO-2 was expressed mainly in the esophagus mucous membrane epithelia both in the normal control group and in RE, HO-1 can protect the esophagus mucous against the damage by iNOS. The expression of HO-1 may play a role in the protection of gastro esophageal tract injury. HO-2 was expressed mainly in the patient's esophagus mucous membrane epithelia in all groups. It indicated that there were not difference between RE groups and the normal control group. 4. The expression of HO-1 was positively correlated with iNOS expression in the esophagus mucous membrane epithelia in RE. 5. HO/CO system and NOS/NO system may play important roles in the pathogenesis of gastrointestinal motility disorders such as RE.