Gastroesophageal reflux disease (GERD) is an important public health problem which is extremely common nowadays. Symptoms of GERD arise from the exposure of increased acid gastric contents into the lower part of the esophageal mucosa. Most patients with GERD have NERD with invisible mucosal damages under endoscopy. There is not a gold standard to diagnose NERD due to the poor sensitivity, specificity, and reproducibility of many existing methods. Dilated intercellular spaces (DIS) in the esophageal epithelium have been a recent research hotspot. DIS has been considered as a feature of esophageal epithelial damage induced by gastric acid reflux, and serves as a marker for new methods to diagnose NERD. Studies have highlighted the importance of refluxed gastric acid in esophageal epithelial DIS. Until now, the specificity of DIS has been questionable.
A research article to be published on March 7, 2010 in the World Journal of Gastroenterology addresses this question. The research team, led by Professor Zhou from Peking University Third Hospital, used transmission electron microscopy to evaluate the esophageal mucosal damages in response to various factors in rats, including acute stress, hydrochloric acid, ethanol, aspirin, and prednisolone.
Five damaging factors produced no lesions or inflammation in esophageal mucosae of rats, whether under gross or routine histological inspections. Esophageal epithelial intercellular space diameters in stress and aspirin groups were significantly greater, nearly three or two-fold respectively, than those in their corresponding control groups. These findings indicate that acute stress and aspirin can induce DIS of the esophageal epithelium in rats, and DIS appears before changes that can be seen in gross and routine histological inspections. Further study showed no significant difference in the intercellular space diameters between the group pretreated with esomeprazole to inhibit gastric acid secretion and the control group, in both stress and aspirin models, suggesting that DIS induced by acute stress and aspirin is not correlated with acid reflux.
By showing that DIS is not related solely to acid reflux, this study suggests that DIS is an early and sensitive, but nonspecific, ultrastructural feature of NERD. These results are beneficial for the diagnosis and differential diagnosis of NERD, and provide useful information for further study on the mechanism of this disease.
Reference: Zhang DH, Zhou LY, Dong XY, Cui RL, Xue Y, Lin SR. Factors influencing intercellular spaces in the rat esophageal epithelium. World J Gastroenterol 2010; 16(9): 1063-1069 http://www.wjgnet.com/1007-9327/16/1063.asp
Correspondence to: Dr. Li-Ya Zhou, Department of Gastroenterology, Peking University Third Hospital, No. 49 Huayuanbei Road, Beijing 100191, China. firstname.lastname@example.org
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About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
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