Dilated intercellular spaces in subtypes of gastroesophagic reflux disease

Abstract

Background: dilatation of the intercellular spaces by electron microscopy has been considered as an early morphological marker of tissue injury in gastroesophageal reflux disease. The degree of dilatation in Barrett's esophagus is currently unknown.Objectives: to determine the frequency of dilated intercellular spaces in Barrett's esophagus.Material and methods: cross-sectional and prospective analysis of consecutive patients with gastroesophageal reflux disease. We selected symptomatic patients > 18 years and both sexes. Patients with recent PPI use (< 14 days), H-2 antagonists, NSAID's or previous upper GI tract surgery were excluded. Variables included: clinical-demographic data, Carlsson-Dent score, conventional endoscopy findings, pH-metry results (in non-erosive) and normal mucosal biopsies at 2 and 5 cm above the squamocolumnar junction. Dilation of intercellular spaces was measured by electron microscopy. Statistics: Chi square test with a significance level 0.05 was calculated. The following four groups were compared: a) non-erosive reflux disease (n = 14); b) erosive esophagitis (n = 5); c) Barrett's esophagus (n = 13); and d) healthy controls (n = 5).Results: the dilation of intercellular spaces was increasingly greater from non-erosive reflux to Barret´s esophagus and higher in biopsies taken at 5 cm than at 2 cm of the squamous columnar junction (2.72 ± 1.35 vs. 1.71 ± 0.48 µm) (p = 0.001). There was no difference between biopsies at 2 and 5 cm in the other groups.Conclusion: dilation of intercellular spaces was greater in Barrett's esophagus than in the other groups and higher at 5 cm from the squamocolumnar junction. RESUMENIntroducción: la dilatación de los espacios intercelulares mediante microscopia electrónica se considera un marcador morfológico temprano de daño tisular en la enfermedad por reflujo gastroesofágico. El grado de dilatación en el esófago de Barrett se desconoce actualmente.Objetivos: determinar la frecuencia y grado de la dilatación de los espacios intercelulares en el esófago de Barrett.Material y métodos: series de casos consecutivos con análisis transversal y prospectivo de pacientes con reflujo gastroesofágico. Criterios de selección: > 18 años, sintomáticos, ambos sexos. Se excluyeron aquellos con ingesta de IBP, antagonistas H-2, AINE y cirugía previa. Tomamos datos clínicos, cuestionario de Carlsson-Dent, endoscopia, pH-metría (no erosivos), y biopsias de la mucosa normal a 2 y 5 cm por encima de la unión escamo-columnar. La medición de la dilatación de los espacios intercelulares fue por microscopia electrónica. Estadística: descriptiva. Prueba de Chi-cuadrado con nivel de significancia de 0,05. Se compararon 4 grupos: a) enfermedad por reflujo no erosiva (n = 14); b) esofagitis erosiva (n = 5); c) esófago de Barrett (n = 13); y d) controles sanos (n = 5).Resultados: hubo mayor dilatación de los espacios intercelulares en el esófago de Barrett (5 cm, 2,72 ± 1,3 µm vs. 2 cm, 1,7 ± 0,48 µm) (p = 0,001). Los otros grupos mostraron menor dilatación y sin diferencias entre los...

Intercellular Space Volume Is Mainly Increased in the Basal Layer of Esophageal Squamous Epithelium in Patients with GERD

“…This finding could also explain why patients with BE have fewer symptoms compared to patients with GERD [27]. Nevertheless, our results are in contrast to one recently published study by Alvaro-Villegas and coworkers who evaluated the dilation of ICS by electron microscopy in patients with BE, NERD, ERD, and healthy controls [32]. They found that the dilation of ICS was increasingly greater from NERD to BE and higher in biopsies taken at 5 cm than at 2 cm of the squamous columnar junction.…”

Is Intercellular Space Different Among Layers in Normal Esophageal Mucosa? An Electron Microscopic Study

“…On the other hand, Barrett's esophagus (BE), an end of the spectrum of GERD, may also be of interest in the ultramicroscopic view. From an electron microscopic investigation, BE was revealed to have a greater DIS compared to NERD or erosive esophagitis [18]. This study did not specifically discern the subdivided epithelial layer, and our result may be of note for investigating strata change seen on BE tissues.…”

The integrity of the esophageal mucosa. Balance between offensive and defensive mechanisms

“…Nonetheless, Barrett's has been produced in a rat model of reflux, is more commonly found in GERD than in healthy subjects and is reported to appear in those with erosive esophagitis that did not initially have Barrett's esophagus(73-75). Moreover, there is evidence that NERD, erosive esophagitis and Barrett's esophagus share a common histopathologic feature within esophageal (squamous) epithelium, that is DIS(34, 76). Since DIS is a reflection of a break in barrier function, it supports the concept that these three forms of GERD share a common pathogenesis (see Figure 2).…”