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Comparative results of esophageal damage in gerd and dger dilation of intercellular spaces as a marker of esophageal injury

, : Comparative results of esophageal damage in gerd and dger dilation of intercellular spaces as a marker of esophageal injury. Digestive Disease Week Abstracts & Itinerary Planner : Abstract No M2079

Background: transmission electron microscopy (TEM) has revealed a new and extremely sensitive marker of damage of esophageal epithelium in GERD i.e, the dilation of intercellular spaces (DIS). Aim: to assess the prevalence of DIS in symptomatic patients affected by GERD or DGER (duodenal gastro esophageal reflux disease) in erosive and non erosive esophagitis and to clarify the entity of injury of esophageal mucosa with particular regards to both causes of damage. Patients and methods: 48 subjects were enrolled. Each subject underwent a 24 h pH monitoring and a DGER monitoring (using Bilitec fiber-optic sensor) to identify in symptomatic patients GERD (n=38) and DGER (n=10) and to define controls (10 subjects asymptomatic with a negative pH-metry and bilimetry). An upper gastro-intestinal endoscopy was performed to take 6 biopsies from normal esophageal appearing mucosa within the lower 5 cm of the esophagus in all patients. The biopsies were analysed at histology and at TEM (at least 10 measurements/each photo with 10 photos each patient). Measurements were taken using a computer on TEM photo micrographs of the specimens. Results: at endoscopy there were esophagitis in 18 patients affected by GERD and in 4 affected by DGER. At histology signs of esophagitis were found in 6 patients with GERD and in 3 patients with DGER. At TEM patients affected by GERD and patients affected by DGER have DIS at least twice or more time greater than controls and no differences were noted between erosive and non erosive disease and between GERD and DGER. Mean maximum value were of 6.5 um and 5.9 um respectively. Conclusions: DIS are quantitative similar in GERD and DGER . This means that at the ultrastructural study of esophageal epithelium, both causes of damage (pure acid and mixed bile and acid reflux) doesn't intensify the entity of injury of the mucosa.


DOI: 10.1016/S0016-5085(03)82078-4

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