The role of gastric pepsin in the inflammatory cascade of XXXX .

@entity1 @entity32 @entity650 @entity2172 @entity39 @entity5 @entity35540 @entity2348 @entity281 @entity687 @entity2346
IMPORTANCE: @entity2346 media is characterized as an ongoing @entity32 with accumulation of an effusion in the middle ear cleft. The molecular mechanisms underlying the pathogenesis, particularly the inflammatory response, remain largely unknown. We hypothesize that aspiration of gastric contents into the nasopharynx may be responsible for the initiation of the inflammatory process or aggravate a preexisting condition. OBJECTIVE: To investigate the correlation of gastric @entity35540 with inflammatory cytokines, @entity2348 , and clinical outcomes. DESIGN, SETTING, AND @entity1 : Prospective study of 129 pediatric @entity1 undergoing myringotomy with tube placement for @entity2346 media at a tertiary care pediatric hospital. MAIN OUTCOMES AND MEASURES: Ear samples were tested for @entity35540 ; cytokines @entity650 , @entity687 , and @entity5 @entity39 factor; and bacterial culture inoculation. Data were analyzed by descriptive statistics and regression analysis to identify risk factors for the presence of @entity35540 and to correlate @entity35540 levels with cytokine levels, @entity281 status, and clinical outcomes. RESULTS: Of the 129 @entity1 , 199 ear samples were obtained; 82 samples (41%) and 64 @entity1 (50%) were positive for @entity35540 as measured by immunoassay. @entity35540 positivity correlated with age younger than 3.0 years (mean [SD], 2.3 [2.1] years in the positive group vs 3.3 [3.0] years in the negative group) and with all 3 cytokine levels (mean [SD] @entity5 @entity39 factor, 29.5 [45.9] pg/mL in the positive group vs 13.2 [21.6] pg/mL in the negative group; @entity650 , 6791.7 [9389.1] pg/mL in the positive group vs 2849.9 [4066.3] pg/mL in the negative group; and @entity687 , 6828.2 [8122.3] pg/mL in the positive group vs 2925.1 [3364.5] pg/mL in the negative group [all P   <   .05]); however, logistic regression analysis showed that only @entity687 (odds ratio, 3.96; 95% CI, 1.3-12.0; P   =   .02) and age (odds ratio, 3.83; 95% CI, 1.2-12.7; P   =   .03) were significant independent variables. No statistically significant association was found with other parameters. Multiple linear regressions revealed that the levels of @entity35540 were correlated with @entity687 levels (R2   =   0.248; P   <   .001) and the need for second or third tubes 6 to 12 months after the first (R2   =   0.102; P   =   .006). The presence of @entity35540 in the middle ear was not associated with increased @entity2348 . @entity687 was independent and significantly associated with both @entity35540 levels and @entity2348 (R2   =   0.144 and 0.263, respectively; P   =   .001 for both). CONCLUSIONS AND RELEVANCE: Extraesophageal reflux as indicated by the presence of @entity35540 is closely involved in the middle ear inflammatory process and may worsen the disease in some @entity1 ; however, a proof of cause and effect between extraesophageal reflux and @entity2172 requires further investigation.
