Dilated intercellular spaces as a marker of oesophageal damage: comparative results in gastro-oesophageal reflux disease with or without bile reflux
Dilated intercellular spaces as a marker of oesophageal damage: comparative results in gastro-oesophageal reflux disease with or without bile reflux
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DOI：
10.1046/j.1365-2036.2003.01713.x
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发表时间：
2003-09-01
影响因子：
7.6
通讯作者：
Di Febo, G
中科院分区：
文献类型：
--
作者：
Calabrese, C;Fabbri, A;Di Febo, G
背景：在透射电子显微镜图像中清晰可见的食管细胞间隙扩张是酸诱导的细胞损伤的标志。目的：分析对照组和胃食管反流病或伴有糜烂性或非糜烂性反流病的十二指肠胃食管反流病患者细胞间隙扩张的存在并量化评分。方法：38 名有症状的胃食管反流病患者反流病或十二指肠胃食管反流和 12 名无症状对照者（根据 pH 测定和胆汁测定进行分类）接受了内窥镜检查。从正常粘膜中取出六个组织活检用于光学显微镜和透射电子显微镜评估。在标本的显微照片上测量扩张的细胞间隙（每个患者至少测量 100 个横断面）。 结果：22 名胃食管反流病患者的肉眼粘膜正常，但在组织学上，5 名糜烂性胃食管反流病患者患有轻度食管炎，1 名患有中度食管炎。 7 名十二指肠胃食管反流患者粘膜正常，而 3 名糜烂性十二指肠胃食管反流患者在组织学上有轻度食管炎。在透射电子显微镜下，所有对照组的细胞间隙均扩张，小于 1.69 μm。每个有症状的患者的平均扩张细胞间隙值和最大扩张细胞间隙平均值比对照组大至少三倍或更多倍（P < 0.001）。糜烂性和非糜烂性食管炎之间没有观察到统计学差异。结论：扩张的细胞间隙是胃食管反流病、十二指肠胃食管反流病和非糜烂性反流病损害的极其敏感的标志物，并且是迄今为止报道的非糜烂性反流病损害评估的最合适的标志物。 0.74 μm 的平均扩张细胞间隙提供了损伤的截止分数。在纯酸反流和混合酸反流之间，未发现扩张的细胞间隙评分存在定量或定性差异。
Background: The dilation of oesophageal intercellular spaces, clearly apparent in transmission electron microscopy images, is a marker of cellular damage induced by acid.Aim: To analyse the presence of dilated intercellular spaces and to quantify the scores in controls and in patients with gastro-oesophageal reflux disease or duodenal gastro-oesophageal reflux accompanied by erosive or non-erosive reflux disease.Methods: Thirty-eight symptomatic patients with gastro-oesophageal reflux disease or duodenal gastro-oesophageal reflux and 12 asymptomatic controls, classified on the basis of pH-metry and bilimetry, underwent endoscopy. Six tissue biopsies were taken from the normal mucosa for light microscopy and transmission electron microscopy evaluation. Dilated intercellular spaces were measured on photomicrographs of the specimens ( at least 100 transects were measured for each patient).Results: Twenty-two patients with gastro-oesophageal reflux disease had normal macroscopic mucosa but, at histology, five patients with erosive gastro-oesophageal reflux disease had mild oesophagitis and one had moderate oesophagitis. Seven patients with duodenal gastro-oesophageal reflux had normal mucosa, whilst three with erosive duodenal gastro-oesophageal reflux had mild oesophagitis at histology. At transmission electron microscopy, all controls had dilated intercellular spaces of less than 1.69 mum. Each symptomatic patient had a mean dilated intercellular space value and a mean value of the maximum dilated intercellular space at least three or more times greater than that in controls ( P < 0.001). No statistical differences were observed between erosive and non-erosive oesophagitis.Conclusions: The dilated intercellular space is an extremely sensitive marker of damage in gastro-oesophageal reflux disease, duodenal gastro-oesophageal reflux and non-erosive reflux disease, and serves as the most appropriate marker of damage evaluation in nonerosive reflux disease reported to date. A mean dilated intercellular space of 0.74 mu m provides a cut-off score for damage. No quantitative or qualitative differences in dilated intercellular space scores were found between pure and mixed acid reflux.