Circumferential and axial distribution of esophageal mucosal damage in reflux disease

Abstract

The aim of this study was to evaluate the axial and radial distribution of histological markers including hyperplasia of the basal cell layer, elongation of the papillae and dilatation of the intercellular spaces of the squamous epithelium in patients with nonerosive reflux disease compared to controls and to relate this to the macroscopic topography in erosive reflux disease. Two different study populations were included in this report. Endoscopic esophageal biopsies were taken from 21 healthy control subjects and 21 nonerosive reflux disease patients before and after 4 weeks of esomeprazole therapy. Endoscopic still images from 50 erosive reflux disease patients were reviewed for the radial orientation of LA grade A and/or B esophagitis (Los Angeles criteria for grading of reflux esophagitis). The 3 o'clock position of the squamocolumnar junction showed significantly thicker basal cell layer (P=0.011) and more intercellular space dilatation (P=0.01) in nonerosive reflux disease patients compared to the 9 o'clock position. Only a significant difference in dilatation of the intercellular spaces (P=0.018) between nonerosive reflux disease patients and controls were observed in the 3 o'clock region at the squamocolumnar junction, whereas 1-2 cm orally, all three histological criteria differed significantly (P<or=0.01). After treatment, on the contrary, papillary length was significantly less pronounced at the squamocolumnar junction (P<0.01). Endoscopically, erosions were predominantly visualized in the 3 o'clock region (P<0.05). Histological mucosal changes in nonerosive reflux disease patients and visible mucosal erosions in erosive reflux disease patients occur most frequently at the same position, namely in the 3 o'clock quadrant in the distal esophagus. The histological difference between nonerosive reflux disease patients and controls are more distinct 1-2 cm oral to rather than at the squamocolumnar junction. However the effect of therapy is most pronounced at the squamocolumnar junction.

Structural Abnormalities of Endoscopy-Negative Reflux Disease – Real or Perceived?

“…Studies initiated by the IWGCO indicate that the lesser curvature or the quadrant between the right and the rear esophageal wall is most affected by reflux-induced epithelial damage [16, 40]. The exact reason is not clear even if interesting and logical explanations do exist [41].…”

“…The same seems to be true for the group of pathologists. Furthermore, it turned out that reflux lesions might be rather localized around the right esophageal wall (or lesser curvature of the stomach) [16]. Only with a standardized approach concerning the exact location of the biopsy was it possible in a study initiated by the IWGCO (International Working Group for Classification of Esophagitis) to document the morphological correlate of the so-called red streaks in the distal esophagus: a newly epithelized lesion with underlying capillary-rich granulation tissue as a result of a healing mucosal break (fig.…”

Pathophysiology of Barrett's Esophagus-Associated Neoplasia: Circumferential Spatial Predilection

“…1). On the other hand, the 3-o'clock position has been defined as the posterior wall of the esophagus in other studies [23,24]. Although it is difficult to judge the circumferential localization of the lesion using endoscopic still images, it is easy for endoscopists to describe a clock face orientation of the esophageal lumen with the endoscope during the procedure.…”

“…Edebo et al [23] investigated the circumferential distribution of histological markers for mucosal damage, including hyperplasia of the basal cell layer, elongation of the papillae, and dilatation of the intracellular spaces of the squamous epithelium at and just above the squamocolumnar junction in patients with nonerosive reflux disease (NERD) by performing 4-quadrant biopsies in these areas, then compared the results with those obtained with healthy subjects. They demonstrated that histological mucosal changes such as a thicker basal cell layer and greater intercellular space dilatation were most prevalent in the posterior wall of the esophagus in patients with NERD.…”

Expression of Reactive Oxygen Species in Reflux Disease

“…The biopsies were collected during endoscopy and specimens were immediately frozen in liquid nitrogen (for later western blot analysis) or snap frozen in RNA STAT-60 (Nordic Bio Site AB, Stockholm, Sweden) (for later rt-PCR analysis) and subsequently stored in liquid nitrogen or fixed in buffered 4% formaldehyde (for later histo-morphology evaluation). The biopsies were taken in the 3 o´clock position 2 cm proximal to the gastro esophageal junction, and in the altered area for the esophagitis (red streak) (8). Protein expressions of MPO, NADPH oxidase, iNOS and nitrotyrosine were assessed by western blot technique and immunohistochemistry.…”