Karnaukh E. V.

Kharkiv National Medical University

Characterisctics of biochemical and immunological parameters of oral fluid in children with pathology
of upper gastrointestinal tract

Background. Recently, a special attention is paid to oral symptoms of gastroenterological diseases which are characterized by gastroesohageal reflux. The influence of acid substances on oral cavity inner tissues is widely known, but information about important causative role of gastric acidity in dental health disorders is relatively recent. Undoubtedly, pathophysiological mechanisms of dental health disorders accompanying so-called “acid-dependent diseases” (gastroesophageal reflux disease, gastritis, peptic ulcer) are much more complicated than just simply direct influence of reflucted sour medium on oral cavity structures. An exceptional role in this process is played by factors of inflammation and interaction with microorganisms. In this relation, the role of sertain endogenic anti-microbial peptides, particularly defensines, is interesting. Three main fractions of these substances are produced in humans practically only by neutrophiles (and this allows to consider them as specific marker of neutrophilic leucocytes), their main physiological role is bactericide action (by creation of ion channels and alteration of cell membranes permeability), and also conduction of chemotactic, immune-modulating, cytotoxic and even anti-viral activity. Nowadays, the interrelation of dental tissues pathologic changes and gastroesophageal reflux in child patients is insufficiently studied, known data is contradictory in many aspects. In relation to above mentioned and taking into account the fact that this problem is insufficiently researched, known information is discrepant, evidence-based researches are rare, is is expedient and topical to conduct a research dedicated to study of clinico-pathogenical aspects in patients with gastroduodenal pathology.

So, a certain relation between diseases of gastrointestinal tract and pathologic processes in oral cavity is known today. But concrete biochemical and immune mechanisms underlying this relation remain to be not clear enough.

Objective. Improvement of diagnosis, prophylaxis and treatment of caries of permanent teeth efficacy in children with gastric acid-dependent diseases accompanied with gastroesophageal reflux by early reveal of caries markers.

Material and methods. A prospective randomized one-time ("cross-sectional") cohort controlled research has been performed in 112 children aged 14 [10; 16] years, 66 boys and 46 girls. Among 88 persons with gastrointestinal pathology the diagnosis of gastroesophageal reflux disease has been stated in 17 (19.3 %) persons, chronic gastroduodenitis – in 56 (63.6 %) persons, duodenal ulcer disease – in 15 (17.1 %) children. Control group included 24 almost healthy children. Biochemical investigations included evaluation of calcium, magnesium, fluorine concentrations, alkaline phosphatase activity in oral fluid. Immunological method has been introduced to estimate immunoglobulin A concentration in saliva. Additionally, an acidity in oral cavity, esophagus and stomach has been evaluated. Non-parametric statistical analysis has been performed, critical p-level was 0.05.

Results and discussion. Salivary contents of Ig A in children with accompanying gastric acid-dependent gastrointestinal pathology was 310 [150; 325] mg/l against 184 [159; 239] mg/l in control, p<0.05. The concentration of Ig А was gradually increasing with growing of gastroenterological anamnesis duration and, in duration of 3 years was highest in duodenal ulcer disease, less in chronic gastroduodenitis and lowest – in gastroesophageal reflux disease; in duration of more than 3 years the nosologic differences were absent. The mucin saliva contents was checked. In patients with background gastroenterological pathology it was 0.36 [0.29; 0.44] g/l against 0.51 [0.42; 0.69] in control, р<0.01. Concentration of lisozyme was measured in saliva. In children with gastric acid-dependent diseases it was 9.1 [8.7; 9.9] mm/ml against 12.1 [10.1; 14.3] mm/ml in control, р<0.01). Lisozyme concentration showed a tendency to diminishing with increase of anamnesis duration increase, without significant nosological differences.

In children with background digestion pathology the alkaline phosphatase in saliva was 116.3 [33.4; 303.6] U/l against 133.7 [97.4; 388.9] U/l in control, р=0.20, growing with increasing of gastroenterological diseases duration and reaching peak values in children with gastroesophageal reflux disease with 1 year duration (69.6 [69.6; 69.6]) and above 3 years (333.4 [173.3; 409.5]), with chronic gastroduodenitis – with 1–3 years duration (171.3 [28.8; 303.6]).

In children with gastroenterological pathology the concentration of magnesium in saliva was 0.34 [0.27; 0.49] mmol/l against 0.38 [0.30; 0.56] mmol/l in control (р=0.38). Maximal values were registered in duration of diseases below 1 year – in children with gastroesophageal reflux disease and chronic gastroduodenitis (0.49 [0.49; 0.49] mmol/l and 0.48 [0.47; 0.51] mmol/l accordingly); in duration of 1–3 years — with duodenal ulcer disease (0.41 [0.27; 0.51] mmol/l); over 3 years – with chronic gastroduodenitis (0.40 [0.31; 0.49] mmol/l). The concentration of calcium in saliva of children with gastroenterological pathology was 1.73 [1.32; 2.11] mmol/l against 1.91 [1.41; 2.44] mmol/l (р=0.30). In gastroesophageal reflux disease and chronic gastroduodenitis the highest values were in below 1 year gastroenterological anamnesis; in chronic gastroduodenitis it gradually lowered with decrease of course duration. On the contrary, in children with duodenal ulcer disease maximal concentration of 2.15 [1.73; 2.26] mmol/l calcium showed in duration of over 3 years.

In saliva of examined children the concentration of phosphorus was checked. In patients with gastroenterological pathology it was 1.73 [1.30; 2.19] mmol/l against 1.66 [1.43; 2.19] mmol/l, the highest in duodenal ulcer disease (1.98 [1.30; 2.31] mmol/l). The acidity of saliva showed the following data. Particularly, in children with accompanying digestive tract diseases the saliva acidity was 5.8 [5.5; 6.0] against 6.0 [5.6; 6.3] in control. The lowest values (5.5 [5.0; 6.0]) were registered in duodenal ulcer disease.

Conclusion. Biochemical and immunological parameters of oral fluid in children with pathology of upper gastrointestinal tract (gastroesophageal reflux disease, chronic gastroduodenitis, duodenal ulcer disease) are characterized by decrease of alkaline phosphatase inhibition; immunoglobulin A, mucin, lysozyme, magnesium, calcium contents in saliva. Further perspectives of research in this direction is characteristics of biophysical parameters of oral fluid in children with pathology of upper gastrointestinal tract.