Esomeprazole induces upper gastrointestinal tract transmucosal permeability increase.

BACKGROUND: Proton pump inhibitors (PPIs) are one of the most widely used drug classes in the US and are now frontline medications for gastro-oesophageal reflux disease (GERD) and dyspepsia. In a previous work, we observed that a transmucosal, upper gastrointestinal (GI) leak exists in Barrett's oesophagus (BO) patients. PPI medications are commonly used by Barrett's patients. AIM: To examine if the PPI, esomeprazole, affects the barrier function of the upper GI tract. METHODS: The sucrose permeability test (SPT) was used to assess the possible effect of the PPI, esomeprazole, on upper GI leak in 37 first-time-presenting GERD patients and 25 healthy controls. RESULTS: Esomeprazole induced a significant transmucosal leak in the upper GI tract of patients taking the drug for the first time. The leak occurred quickly, within days of first taking the drug. The leak was also reversed within days of stopping the medication. CONCLUSIONS: This is the first patient-based study showing that a PPI compromises upper GI barrier function. There are potential implications for transmucosal leak of other medications that a patient on a PPI may be taking, as well as possible leak of endogenous peptides/proteins. The clinical consequences of this phenomenon are currently unknown, but are potentially important.

A review of the population biology and host-parasite interactions of the sea louse Lepeophtheirus salmonis (Copepoda: Caligidae).

Lepeophtheirus salmonis is a specific parasite of salmonids that occurs in the Atlantic and Pacific Oceans. When infestations are heavy fish mortality can occur although the factors that are responsible for causing epizootics, especially in wild salmonid populations are still largely unknown. Over the past 20 years this parasite has caused significant economic losses in farmed salmon production and possibly in wild salmonid populations locally. Understanding the connectivity between populations is crucial to an understanding of the epidemiology of infections and for management of infections in aquaculture. Data from genetics, pesticide resistance, larval dispersal models and spatial and temporal patterns of infestation in wild and farmed hosts suggests a spatially highly structured metapopulation the components of which have different levels of connectivity, probabilities of extinction and influence on the development of local infestations. The population structure is defined mainly by the dispersal dynamics of the planktonic stages and the behaviour of the host. Until recently virtually nothing was known about the relationship between the parasite and the host, or how the host may influence lice at local or population level. Typically, impacts on the host have usually been reported in terms of pathological lesions caused by attachment and feeding of the adult stages, as well as localised mild epithelial responses to juvenile attachment. However many studies report pathology associated with severe infestation. Recent new studies on the host-parasite interactions of L. salmonis have shown that this parasite induces stress-related responses systemically in the host skin and gills and that the stress response and immune systems are modulated. In the second part of this review, these new studies are presented, together with results from other host-parasite model systems where data for caligid sea lice are missing. One of the most revealing methods reported recently is the application of a net confinement stressor to examine modulation of the stress response and immune system of the host fish. This approach has shown that although until now, infective stages of L. salmonis were not thought to affect the host, they do induce systematic effects in the host that result in a stress response and modulated immune system. Host-parasite interactions affecting these stress responses and the immune system may be key factors in facilitating epizootics by reducing the host's ability to reject the parasites, as well as reducing disease resistance under some environmental conditions. The host-parasite interaction therefore needs to be incorporated into any model of population structure and dynamics.

Spatial and temporal variation in the infestation of sea trout (Salmo trutta L.) by the caligid copepod Lepeophtheirus salmonis (Krøyer) in relation to sources of infection in Ireland.

Infestations of post-smolt sea trout (Salmo trutta L.) by the salmon louse (Lepeophtheirus salmonis Krøyer) were characterized in 42 estuaries over a 5 year period in Ireland. Spatial variation in infestation was more significant than temporal trends and existed at 3 levels; between regions (regions > 100 km of coastline), between bays within regions (bays < 50 km in length) and between estuaries within bays (distance between estuaries < 10 km). The observed spatial structure in infestations inferred that production of the infective larvae varied between regions and bays and that there was limited movement of fish and infective larvae between regions and bays. In addition the different levels of infestation recorded between estuaries in the same bay indicated short spatial scale variability in parasite transmission. Significantly higher infestations occurred in bays that contained lice-infested farmed salmon. Lice-infested wild spring salmon, which were present in estuaries of some systems, did not have a significant positive impact on infestations.