Reversibility of GERD Ultrastructural Alterations and Relief of Symptoms After Omeprazole Treatment

Calabrese, Carlo; Bortolotti, Mauro; Fabbri, Anna Adele; Areni, Alessandra; Cenacchi, Giovanna; Scialpi, C.; Miglioli, M.; Febo, Giulio Di

doi:10.1111/j.1572-0241.2005.40476.x

Cited by 190 publications

(169 citation statements)

References 21 publications

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“…When the intercellular spaces become widened, acid and pepsin refluxed from the stomach can easily penetrate the epithelial layer and stimulate noxious receptors on the afferent neurons and induce reflux symptoms [5] . An association between widened intercellular spaces and reflux symptoms has been reported [11,12] . In order to enter the mucosal intercellular spaces, acid and pepsin have to penetrate the intercellular adhesion sites of the uppermost superficial epithelial cells.…”

Section: Discussionmentioning

confidence: 99%

“…In order for acid and pepsin to penetrate into the intercellular spaces, the intercellular adhesion of the uppermost squamous epithelial cells needs to be damaged or widened [5,9,10] . Several reports have described the widening of intercellular spaces between squamous epithelial cells in mid-stratified epithelial layers by using transmission electron microscopy (TEM) [9][10][11][12] . However, there has been no description of intercellular adhesion between cells located in the uppermost part of the stratified squamous epithelium, since intercellular spaces of esophageal superficial epithelium could not be observed by TEM.…”

Section: Introductionmentioning

confidence: 99%

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Esophageal epithelial surface in patients with gastroesophageal reflux disease: An electron microscopic study

Azumi¹,

Adachi²,

Furuta³

et al. 2008

WJG

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AIM:To investigate the intercellular spaces between the most superficially located esophageal epithelial cells in patients with gastroesophageal reflux disease (GERD). METHODS: Eighteen patients with erosive esophagitis, 10 patients with non-erosive reflux disease (NERD), and 18 normal asymptomatic volunteers were enrolled. Biopsy specimens were obtained from the lower esophageal mucosa without ulcer or erosion. Scanning electron microscopy was employed to investigate the tightness of the superficial cellular attachment. RESULTS:The intercellular space between the most superficially located epithelial cells in patients with erosive esophagitis or NERD was not different from that in asymptomatic healthy individuals. CONCLUSION: Widened luminal intercellular spaces of esophageal superficial epithelium are not responsible for the induction of reflux symptoms in patients with GERD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Esophageal epithelial surface in patients with gastroesophageal reflux disease: An electron microscopic study

Azumi¹,

Adachi²,

Furuta³

et al. 2008

WJG

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“…Acid perfusion in the esophagus can provoke a dilated intercellular space, 13,21,22 and most patients achieve recovery from this dilation after PPI therapy. 23,24 Thus, it can be easily speculated that the low IB of the distal esophagus in globus patients is the consequence of acid injury to the esophageal mucosa. In addition to the lower IB of the distal esophagus, the IB values in the proximal esophagus at positions 15 and 17 cm from the LES in the acid reflux patients were lower than those in the other 2 groups, although these findings were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Is the Impedance Baseline Helpful in the Evaluation of Globus Patients?

Chun

Choi

Kim

et al. 2015

J Neurogastroenterol Motil

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Background/AimsGastroesophageal reflux disease (GERD) has been suggested to be responsible for 23-68% of globus cases. The impedance baseline (IB) acquired by 24-hour multichannel intraluminal impedance monitoring has been proven to represent esophageal mucosal integrity. We aimed to investigate whether the IB is helpful for evaluating globus patients. MethodsTwenty-four-hour multichannel intraluminal impedance pH tracings (MII-pH) were evaluated in globus patients. Differences in the IB between the acid reflux, non-acid reflux, and no reflux groups were analyzed. Receiver operating characteristic (ROC) curves were obtained to determine the optimal measurement point from the lower esophageal sphincter (LES). ResultsA total of 62 patients were analyzed. MII-pH showed that acid reflux, non-acid reflux, and no reflux were present in 13, 5, and 44 patients, respectively. The acid reflux group had a significantly lower IB than the other groups at a location 3 cm from the LES. ROC curve analysis revealed that placement at a position 3 cm from the LES resulted in moderate diagnostic accuracy (area under the curve = 0.88). When we set 2500 Ω as the cut-off value for acid reflux at a position 3 cm from the LES, the additional diagnostic yield for acid reflux was increased by 19.4% compared with that obtained by MII-pH. ConclusionsIB is complementary to pH findings enabling identification of a subset of patients with co-existing acid reflux. Catheter placement at a location 3 cm from the LES and a cut-off value of 2500 Ω may be reasonable criteria for estimating acid reflux.

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“…9,10 Some researchers have suggested that DIS can be used as an objective indicator for NERD. 11,12 However, this method of GERD diagnosis is invasive and costly. Therefore, researchers have shifted their attention toward a simpler and less expensive technique: saliva pepsin testing.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Salivary Pepsin Concentration and Esophageal Mucosal Integrity in Patients With Gastroesophageal Reflux Disease

Sifrim

Xie

et al. 2017

J Neurogastroenterol Motil

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Background/AimsIncreased salivary pepsin could indicate an increase in gastro-esophageal reflux, however, previous studies failed to demonstrate a correlation between salivary pepsin concentrations and 24-hour esophageal acid exposure. This study aims to detect the salivary pepsin and to evaluate the relationship between salivary pepsin concentrations and intercellular spaces (IS) in different gastroesophageal reflux disease phenotypes in patients. MethodsA total of 45 patients and 11 healthy volunteers were included in this study. All subjects underwent upper gastrointestinal endoscopy, 24-hour ambulatory multichannel impedance-pH (MII-pH) monitoring, and salivary sampling at 3-time points during the 24-hour MII-pH monitoring. IS were measured by transmission electron microscopy, and salivary pepsin concentrations were determined by enzyme-linked immunosorbent assay. ResultsThe IS measurements were greater in the esophagitis (EE), non-erosive reflux disease (NERD), and hypersensitive esophagus (HO) groups than in the functional heartburn (FH) and healthy volunteer groups, and significant differences were indicated. Patients with NERD and HO had higher average pepsin concentrations compared with FH patients. A weak correlation was determined between IS and salivary pepsin among patients with NERD (r = 0.669, P = 0.035). ConclusionsWe confirmed the presence of a higher level of salivary pepsin in patients with NERD than in patients with FH. Salivary pepsin concentrations correlated with severity of mucosal integrity impairment in the NERD group. We suggest that in patients with NERD, low levels of salivary pepsin can help identify patients with FH, in addition the higher the pepsin concentration, the more likely the severity of dilated IS.

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Reversibility of GERD Ultrastructural Alterations and Relief of Symptoms After Omeprazole Treatment

Abstract: Three and six months of omeprazole therapy led to a complete recovery of DIS in 92.1% and 97.4% of cases, respectively. No significant differences of DIS between NERD and EE were noted. Complete recovery of DIS was accompanied by regression of heartburn in all cases.

Cited by 190 publications

References 21 publications

Esophageal epithelial surface in patients with gastroesophageal reflux disease: An electron microscopic study

Esophageal epithelial surface in patients with gastroesophageal reflux disease: An electron microscopic study

Is the Impedance Baseline Helpful in the Evaluation of Globus Patients?

Relationship Between Salivary Pepsin Concentration and Esophageal Mucosal Integrity in Patients With Gastroesophageal Reflux Disease

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