A prospective study of extraesophageal reflux and potential microaspiration in patients hospitalized with COVID-19 in Jordan

BMC Pulmonary Medicine

Research

Abdel-Ellah AL-Shudifat¹  Hafez Al-Momani²  Safaa Mashal²  Ashraf I Khasawneh²  Dua’a Al Balawi³  Muna Almasri³  Jeffrey Pearson⁴  Christopher Ward⁴ 

[1] Department of Internal and family Medicine, Faculty of Medicine, The Hashemite University, 13133, Zarqa, Jordan;Department of Microbiology, Pathology and Forensic medicine, Faculty of Medicine, The Hashemite University, 13133, Zarqa, Jordan;Faculty of Applied Medical Sciences, The Hashemite University, 13133, Zarqa, Jordan;Translational and clinical research and Biosciences institutes, Newcastle University Medical School, Newcastle University, NE2 4HH, Newcastle upon Tyne, UK;

关键词: COVID-19;    Gastrointestinal system;    COVID-19 transmission;    Pepsin;    Extraesophageal reflux;   

DOI  :  10.1186/s12890-023-02638-7

 received in 2023-03-17, accepted in 2023-09-07,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lung infection has represented a global challenge. Intriguingly, it has been shown that the alveolar lung epithelium expresses little Angiotensin Converting Enzyme receptor protein (ACE2), the entry receptor for SARS-CoV-2. Upper airway establishment of infection and translocation to the lung is well documented but other anatomical niches may be relevant to potentially serious lung infection. ACE2 is heavily expressed in the gastrointestinal tract and gastrointestinal symptoms support a clinical diagnosis of Coronavirus disease 2019 (COVID-19). This suggests a research question and the need to gather patient data exploring potential aerodigestive links in SARS-CoV-2 tranlocation and infection which may be relevant in the peripheral lung. This recognizes anatomical proximity and concepts of bi-directional movement between the Gastrointestinal and lung systems in normal physiology and disease. We have therefore explored the potential for gastro oesophageal reflux disease (GORD) micro aspiration and aeorodigestive pathophysiology in a novel prospective investigation of patients hospitalized with COVID-19.MethodsThis is a prospective descriptive cohort study of 210 patients who were hospitalized with a confirmed diagnosis of COVID-19. The cohort was divided into three groups of patients based on symptom severity and radiological results. The Reflux Symptom Index (RSI) was used to evaluate the presence and severity of GOR. An RSI greater than 13 is considered to be abnormal. Patients’ saliva samples were tested using enzyme-linked immunosorbent assay (ELISA) to determine the level of salivary pepsin among the cohort of patients.ResultsA total of 210 patients with COVID-19 were enrolled in the study with 55.2% (116/210) classified as mildly ill, 31.9% (67/210) moderately ill and 12.9% (27/210) as severely ill. 34% (72/210) of the patients had an RSI score of over 13 and a median salivary pepsin value of 54 ± 29 ng/ml which suggested an incidence of extraesophageal reflux (EOR) in around a third of patients. The presence of respiratory comorbid conditions, an RSI score of over 13 and a salivary pepsin level of > 76ng/ml increased the risk of developing a more severe COVID-19 infection.ConclusionThe study showed a high prevalence of EOR among the study cohort and provide the first prospective evidence suggesting the potential for aerodigestive pathophysiology including microaspiration in COVID-19 disease. We believe that the results of our study support the need for more extensive research.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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