The role of hormones in symptoms and pathophysiology of reflux and esophageal motility disorders

Abstract

Purpose A few studies suggest that hormones play a role in the motility of the lower esophagus, but data is rare. In this prospective study we evaluated the correlation between hormones (TSH, fT3, fT4, calcitonin, gastrin, and VIP) and gastroesophageal reflux disease (GERD), esophageal motility disorders, and gastrointestinal symptoms.

Methods 100 consecutive patients with reflux symptoms and dysphagia were hospitalized for diagnostic evaluation. Self-reporting questionnaires were handed out and patients routinely underwent serum analysis (TSH, fT3, fT4, calcitonin, gastrin, and VIP), 24-hour-pH-impendance monitoring, and high-resolution manometry.

Results Motility disorders were found in 38 out of 86 patients. There were no correlations between hormones, the DeMeester Score, and the lower esophageal sphincter pressure. A strong inverse relation between calcitonin and the Integrated Relaxation Pressure of the esophagogastric junction was found (r=–0.492; p<0.001). No correlations were found between hormone levels and the responses given in the questionnaires. Positive correlations, however, were found between VIP and gastrointestinal symptoms, as well as correlations between fT3 and dysphagia. Within the group with minor motility disorders, TSH and fT4 correlated with outcomes of the SCL-questionnaire. fT4 correlated with the typical symptoms, as well as the gastrointestinal symptoms (diarrhea, constipation, flatulence). TSH correlated with the typical symptoms. Moreover, a correlation between VIP and gas-bloat-symptoms was found within group II

Conclusions No correlation between TSH, fT3, fT4, gastrin, VIP, calcitonin, and GERD in the sense of acid reflux was found, although calcitonin seems to have an effect on the lower esophageal sphincter.

Zusammenfassung

Hintergrund Ein Zusammenhang zwischen Hormonen und Motilität des Ösophagus wird in einzelnen Studien beschrieben, jedoch gibt es hierfür kaum Daten. In unserer prospektiven Untersuchung wollten wir den Zusammenhang zwischen Hormonen (TSH, fT3, fT4, Calcitonin, Gastrin und VIP) und der gastroösophagealen Refluxkrankheit (GERD), Motilitätsstörungen und gastrointestinalen Symptomen untersuchen.

Methoden 100 Patienten mit Refluxsymptomen und/oder Dysphagie wurden zur stationären Abklärung aufgenommen. Validierte Fragebögen wurden ausgehändigt, 24-Stunden-pH-Impendanz-Monitoring und hochauflösende Manometrie wurden durchgeführt. Des Weiteren erfolgte eine Serumanalyse von TSH, fT3, fT4, Calcitonin, Gastrin und VIP.

Ergebnisse Motilitätsstörungen fanden sich in 38 von 86 Patienten. Es zeigte sich kein Zusammenhang zwischen Hormonen, dem DeMeester-Score und dem Druck des unteren Ösophagussphinkters, jedoch eine starke inverse Korrelation zwischen Calcitonin und der Integrated Relaxation Pressure (IRP) des gastroösophagealen Übergangs (r=–0,492; p<0,001). Des Weiteren zeigten sich keine Zusammenhänge zwischen Hormonwerten und den Ergebnissen von Symptom-Fragebögen. Positive Korrelation zeigte sich bei VIP und gastrointestinalen Symptomen sowie bei fT3 und Dysphagie. In der Gruppe mit „minor motility disorders“ korrelierten TSH und fT4 mit typischen Symptomen und fT4 mit gastrointestinalen Symptomen (Durchfall, Obstipation, Flatulenz) sowie VIP mit „gas-bloat“-Symptomen.

Zusammenfassung Wir konnten keinen Zusammenhang zwischen TSH, fT3, fT4, Gastrin, VIP und Calcitonin mit der gastroösophagealen Refluxkrankheit im Sinne einer Säureexposition zeigen, jedoch scheint Calcitonin einen Effekt auf den unteren Ösophagussphinkter zu haben.

Schlüsselwörter

GERD - NERD - Ösophagus - Hormone - Motilität

Keywords

GERD - NERD - esophagus - hormones - motility

Publication History

Received: 02 January 2022

Accepted after revision: 15 April 2022

Article published online:
13 June 2022

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