Diagnostic value of dilated intercellular space and histopathologic scores in gastroesophageal reflux disease

Abstract

The aim of this paper is to investigate the diagnostic value of histopathologic score and the dilated intercellular space (DIS) in patients with gastroesophageal reflux disease (GERD) and functional heartburn (FH). Participants with GERD symptoms including reflux esophagitis, non-erosive reflux disease (NERD), Barrett's esophagus (BE), functional heartburn (FH), along with a control group with atypical GERD-like symptom (Sym-C), and asymptomatic healthy volunteers (H-C) were administered GERD questionnaire, and subjected to endoscopy and biopsies, as well as 24-hour pH-impedance monitoring. Biopsies were evaluated using standards from the 2011 Esohisto Project after Hematoxylin-Eosin staining. DIS was measured quantitatively under light microscopy. Among the total of 565 participants with qualified biopsy specimens, the mean DIS of the reflux esophagitis (RE) group was significantly wider compared with the other five groups. DIS in patients with GERD-like symptoms was significantly wider compared with the H-C. No significant differences were observed between NERD and FH. Results from 24-hour pH-impedance monitoring indicated that only the DIS of patients with acid reflux or the amount of acid reflux episodes in patients with DIS was significantly wider compared with patients with nonacid reflux or patients without DIS (P < 0.001). With DIS = 0.9 μm as the cutoff value, the sensitivity and specificity were 62.6% and 54.1%, respectively. Using the total histopathologic score > 3 as the diagnostic criterion, the sensitivity and specificity were 71.7% and 47.4%. DIS is closely associated with GERD and acid reflux. The diagnostic value of histological scores in lower esophagus in GERD is very similar to that of the quantitative measurement of DIS.

Lubiprostone protects esophageal mucosa from acid injury in porcine esophagus

“…A decrease in TER has been correlated with both compromised barrier function and an increase in sensitivity to acid in patients with esophageal disorders (5,7,24,35,36,49). Additionally, these dilated intercellular spaces are similar to histopathological findings in patients with GERD (12,43). Importantly, in our ex vivo acid injury model, dilatation of interepithelial spaces was markedly reduced by pretreatment with lubiprostone before acid exposure.…”

Assessing different diagnostic tests for gastroesophageal reflux disease: a systematic review and network meta-analysis

“…After full-text review, studies unrelated to diagnostic tests for GERD ( n = 23), studies not in English/Chinese language ( n = 2), and studies not eligible for enrollment ( n = 3) were excluded. Altogether, a total of 40 published studies meeting the predetermined inclusion criteria were identified 13–52 (Figure 1).…”

Endoscopic assessment and grading of Barrett's esophagus using magnification endoscopy and narrow band imaging: Impact of structured learning and experience on the accuracy of the Amsterdam classification system

“…There are no published studies specifically evaluating dilated intercellular space in BE under PPI therapy. Two related studies in GERD that included BE patients had smaller sample of BE patients (181,182) and PPI therapy was excluded. Thus, in these studies the increased dilated intercellular space could be related to increased acid reflux.…”