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Evaluation of Acute Mountain Sickness by Unsedated Transnasal Esophagogastroduodenoscopy at High Altitude

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dc.contributor.author Fruehauf, H.
dc.contributor.author Vavricka, S.R.
dc.contributor.author Lutz, T.A.
dc.contributor.author Gassmann, M.
dc.contributor.author Wojtal, K.A.
dc.contributor.author Erb, A.
dc.contributor.author Maggiorini, M.
dc.contributor.author Schwizer, W.
dc.contributor.author Fried, M.
dc.contributor.author Fox, M.
dc.contributor.author Goetze, O.
dc.contributor.author Greuter, T.
dc.date.accessioned 2020-12-14T16:06:23Z
dc.date.available 2020-12-14T16:06:23Z
dc.date.issued 2020
dc.identifier.uri https://hdl.handle.net/20.500.12866/8711
dc.description.abstract Background & Aims: It is not clear how rapid ascent to a high altitude causes the gastrointestinal symptoms of acute mountain sickness (AMS). We assessed the incidence of endoscopic lesions in the upper gastrointestinal tract in healthy mountaineers after a rapid ascent to high altitude, their association with symptoms, and their pathogenic mechanisms. Methods: In a prospective study, 25 mountaineers (10 women; mean age, 43.8 ± 9.5 y) underwent unsedated, transnasal esophagogastroduodenoscopy in Zurich (490 m) and then on 2 test days (days 2 and 4) at a high altitude laboratory in the Alps (Capanna Regina Margherita, 4559 m). Symptoms were assessed using validated instruments for AMS (the acute mountain sickness score and the Lake Louise scoring system) and visual analogue scales (scale, 0–100). Levels of messenger RNAs (mRNAs) in duodenal biopsy specimens were measured by quantitative polymerase chain rection. Results: The follow-up endoscopy at high altitude was performed in 19 of 25 patients on day 2 and in 23 of 25 patients on day 4. The frequency of endoscopic lesions increased from 12% at baseline to 26.3% on day 2 and to 60.9% on day 4 (P < .001). The incidence of ulcer disease increased from 0 at baseline to 10.5% on day 2 and to 21.7% on day 4 (P = .014). Mucosal lesions were associated with lower hunger scores (37.3 vs 67.4 in patients without lesions; P = .012). Subjects with peptic lesions had higher levels of HIF2A mRNA, which encodes a hypoxia-induced transcription factor, and ICAM1 mRNA, which encodes an adhesion molecule, compared with subjects without lesions (fold changes, 1.38 vs 0.63; P = .001; and 1.37 vs 0.66; P = .011, respectively). Conclusions: In a prospective study of 25 mountaineers, fast ascent to a high altitude resulted in rapid onset of clinically meaningful mucosal lesions and ulcer disease. Duodenal biopsy specimens from these subjects had increased levels of HIF2A mRNA and ICAM1 mRNA, which might contribute to the formation of hypoxia-induced peptic lesions. Further studies are needed of the mechanisms of this process. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Clinical Gastroenterology and Hepatology
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Acute Mountain Sickness en_US
dc.subject Transnasal Esophagogastroduodenoscopy en_US
dc.subject High Altitude en_US
dc.title Evaluation of Acute Mountain Sickness by Unsedated Transnasal Esophagogastroduodenoscopy at High Altitude en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.cgh.2019.11.036
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.19
dc.relation.issn 1542-7714


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