Evidence is accumulating that epidermal growth factor (EGF) is a major molecule contributing to the maintenance of the integrity of the upper alimentary tract mucosa before and after injury by acid and pepsin. Patients with Zollinger-Ellison Syndrome (ZES) typically have hypersecretion of acid and pepsin; however, the concentration and rate of secretion of salivary and gastric EGF that could counteract these potentially aggressive factors are unknown. Accordingly, this study was conducted to determine whether EGF affords mucosal protection in ZES patients.
The concentration and output of salivary (sEGF) and gastric epidermal growth factor (gEGF) were measured in eight patients with ZES and the results compared to those in 17 patients with nonulcer dyspepsia (NUD), serving as a control group. All patients had normal esophageal and gastric mucosa as determined by endoscopy. Total saliva was collected during 1-h parafilm- and 1-h pentagastrin/parafilm-stimulated conditions, as well as basal and pentagastrin-stimulated gastric juice. The concentration and output of EGF were determined by radioimmunoassay.
The concentration of EGF in saliva collected from ZES patients after parafilm chewing was significantly higher compared to that in NUD patients (4.61 ± 0.59 vs 2.75 ± 0.50 ng/ml, p < 0.05). The concentration of EGF in saliva collected after pentagastrin stimulation in ZES patients was also significantly higher than in NUD patients (4.37 ± 0.73 vs 2.22 ± 0.37 ng/ml, p < 0.05). Salivary EGF output during parafilm chewing in ZES and NUD were similar (68 ± 6.4 vs 109 ± 25.2 ng/h). Salivary EGF output after administration of pentagastrin in ZES and NUD was also similar (66 ± 6.1 vs 132 ± 45.4 ng/h). Basal EGF output in the gastric juice of patients with ZES was 3-fold higher than in patients with NUD (801 ± 73 vs 271 ± 32 ng/h, p < 0.01). Pentagastrin-stimulated EGF output was similar in both groups (705 ± 92 vs 675 ± 168 ng/h).
Patients with ZES have a significantly higher EGF concentration in saliva and EGF output in basal gastric juice. This elevated content of salivary and gastric EGF in ZES patients may play a protective role in preventing the development of reflux esophagitis and gastric ulcer under the impact of gastric acid and pepsin hypersecretion.
1Kansas University Medical Center, Kansas City, Kansas, USA
2University of California at Los Angeles, VA Greater Los Angeles Healthcare System at West LA, Los Angeles, California, USA
3Digestive Diseases Branch, National Institutes of Health, Bethesda, Maryland, USA
4University of Virginia Health Sciences Center, Charlottesville, Virginia, USA
Reprint requests and correspondence: Joseph R Pisegna, MD, Veterans Affairs Greater Los Angeles Health Care System, Affiliated Training Programs in Gastroenterology, University of California at Los Angeles, West Los Angeles Veterans Affairs Medical Center, Building 115, Room 316, Los Angeles, CA 90073.
Received 15 July 1999; accepted 29 December 1999