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Dilated intercellular spaces as a marker of GERD.
Lori A Orlando1, Roy C Orlando
1Wallace Clinic, Durham, NC 27705, USA. lorlando@notes.duke.edu
Current Gastroenterology Reports
|May 26, 2009
Summary
Gastroesophageal reflux disease (GERD) patients with heartburn may have nonerosive reflux disease (NERD). Proton pump inhibitor (PPI)-responsive NERD is linked to dilated intercellular spaces (DIS) in the esophageal epithelium, indicating a barrier defect.
Area of Science:
- Gastroenterology
- Esophageal Pathophysiology
- Epithelial Biology
Background:
- Gastroesophageal reflux disease (GERD) presents with heartburn, affecting one-third with erosive esophagitis and the remainder with nonerosive reflux disease (NERD).
- A significant portion of NERD patients (approx. 50%) exhibit limited response to proton pump inhibitor (PPI) therapy, questioning the underlying cause of their symptoms.
- Recent studies reveal that PPI-responsive NERD shares histopathological features with erosive esophagitis, specifically dilated intercellular spaces (DIS) in the esophageal epithelium.
Purpose of the Study:
- To explore the physicochemical basis of dilated intercellular spaces (DIS) in acid-injured esophageal epithelium.
- To elucidate the significance of DIS as a potential marker in GERD.
- To investigate the link between DIS, PPI responsiveness, and epithelial barrier function in NERD.
Main Methods:
- Histopathological examination of esophageal biopsies from GERD patients.
- Analysis of epithelial lesions, focusing on dilated intercellular spaces (DIS).
- Correlation of DIS presence with PPI responsiveness and symptom presentation in NERD.
Main Results:
- Dilated intercellular spaces (DIS) were identified in the esophageal epithelium of GERD patients with PPI-responsive NERD.
- These DIS lesions are similar to those observed in erosive esophagitis.
- DIS serves as a marker for a compromised epithelial barrier, characterized by increased paracellular permeability.
Conclusions:
- Dilated intercellular spaces (DIS) are a key finding in PPI-responsive NERD, indicating a break in the esophageal epithelial barrier.
- The presence of DIS suggests increased paracellular permeability, contributing to GERD symptoms.
- While not exclusive to GERD, DIS is a significant indicator of epithelial barrier dysfunction in this condition.
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