The gastric mucosal epithelial barrier: role of mucus and fibrin

A continuous layer of insoluble mucus gel is adherent to the luminal surface of the gastric epithelium. The true thickness of the gel and its continuity can only be observed on unfixed sections of mucosa since histological fixatives cause dehydration and denaturation of mucus. The mucus:bicarbonate barrier can protect the undamaged epithelium from the endogenous luminal aggressors acid and pepsin but does not appear to offer much protection against exogenous damaging agents such as topical alcohol. Following acute ethanol injury, damaged epithelium is replaced by cells migrating from the gastric pits. In rat gastric mucosa this process of re-epithelialisation is protected by a gelatinous coat ten times thicker than the normal adherent mucus layer. Our studies now show this coat to be a fibrin gel with mucus and necrotic cells. Evidence suggests that the existing mucus layer can act as a template for the fibrinogen--fibrin conversion. These results demonstrate that a fibrin based gelatinous coat, quite distinct from the adherent mucus layer and with considerable protective potential, can be formed over the repairing damaged gastric mucosa.