|dc.contributor.author||Norder Grusell, Elisabeth||
|dc.description.abstract||Gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE)
are the two most common diseases causing inflammation of the esophagus,
namely, esophagitis. GERD and EoE are different in many aspects, but shares
histological similarities and may overlap in symptomatology.
Aims: The overall aim of this thesis was to investigate and compare different
aspects of GERD and EoE including the pathophysiology, with a focus on
bacteriology, and symptomatology. The esophageal bacteriological
occurrence in subjects with GERD, EoE and in healthy volunteers (HV) was
studied. The use of the GerdQ questionnaire in subjects with atypical
symptoms of GERD as well as EoE was evaluated. The association between
the grade of esophageal eosinophilia and symptoms/health-related quality of
life (HRQL) was examined in subjects with active EoE.
Methods and results: Esophageal brush samples and biopsies from HV
(n=40) as well as from subjects with GERD (n=17) and EoE (n=10) were
collected and cultivated. Bacteria were generally present in low amounts in
most subjects and were predominantly various streptococcal species (viridans
streptococci). Subjects with EoE had a significantly more diverse cultivable
esophageal bacterial flora than subjects with GERD and HV had. In subjects
referred for 24-h pH monitoring for typical and/or atypical symptoms
suggestive of GERD (n=646) the GerdQ questionnaire was filled out before
the examination. Of these subjects 57% had atypical symptoms, and 58% had
GERD according to the pH-metry (GERDpH). GerdQ had a sensitivity and
specificity for GERDpH of 62% and 74%, respectively, at a cut-off of 8. In
subjects with active, untreated EoE (n=65) the esophageal eosinophil density
was compared to the severity of disease according to symptoms/HRQL
evaluated by questionnaires (Watson Dysphagia Scale, EORTC QLQOES18,
SF-36). No correlation between these variables was found. However,
subjects with concomitant bolus impaction had higher numbers of
eosinophils in the proximal esophagus.
Conclusions: Subjects with EoE have a more diverse cultivable esophageal
bacterial flora than subjects with GERD and HV have. GerdQ has a
diagnostic value in a population including subjects with atypical main
symptoms of GERD. No correlation between the grade of esophageal
mucosal eosinophilia and symptoms or HRQL was found.||sv
|dc.relation.haspart||I. Norder Grusell E, Dahlén G, Ruth M, Ny L, Quiding-Järbrink M, Bergquist H, Bove M.
Bacterial flora of the human oral cavity, and the upper and lower esophagus.
Dis Esophagus 2013; Jan 26(1): 84-90. ::PMID::22394217||sv
|dc.relation.haspart||II. Norder Grusell E, Dahlén G, Ruth M, Bergquist H, Bove M.
The cultivable bacterial flora of the esophagus in subjects with esophagitis.
Scand J Gastroenterol. 2018; Apr. Epub ahead of print. ::PMID::29616839||sv
|dc.relation.haspart||III. Norder Grusell E, Mjörnheim A-C, Finizia C, Ruth M, Bergquist H.
The diagnostic value of GerdQ in subjects with atypical symptoms of gastroesophageal reflux disease.
|dc.relation.haspart||IV. Larsson H, Norder Grusell E, Tegtmeyer B, Ruth M, Bergquist H, Bove M.
Grade of esosinophilia versus symptoms in patients with dysphagia and esophageal eosinophilia.
Dis Esophagus. 2016; Dec 29(8): 971-976. ::PMID::26390287||sv
|dc.subject||gastroesophageal reflux disease||sv
|dc.subject||quality of life||sv
|dc.title||Esophagitis: Aspects on bacteriology, pathophysiology and symptomatology||sv
|dc.type.degree||Doctor of Philosophy (Medicine)||sv
|dc.gup.origin||University of Gothenburg. Sahlgrenska Academy||sv
|dc.gup.department||Institute of Clinical Sciences. Department of Otorhinolaryngology||sv
|dc.gup.defenceplace||Fredagen den 8 juni 2018, kl. 9.00, Hörsal Arvid Carlsson, Academicum, Medicinaregatan 3||sv