Calabrese C, Fabbri A, Bortolotti M, Cenacchi G, Areni A, Scialpi C, Miglioli M, Di Febo G
Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy.
Aliment Pharmacol Ther. 2003 Sep 1;18(5):525-32. doi: 10.1046/j.1365-2036.2003.01713.x.
The dilation of oesophageal intercellular spaces, clearly apparent in transmission electron microscopy images, is a marker of cellular damage induced by acid.
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.
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).
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 microm. 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.
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 non-erosive reflux disease reported to date. A mean dilated intercellular space of 0.74 micro 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.
在透射电子显微镜图像中明显可见的食管细胞间隙扩张，是酸诱导细胞损伤的标志物。
分析细胞间隙扩张的存在情况，并对对照组以及患有胃食管反流病或十二指肠胃食管反流并伴有糜烂性或非糜烂性反流病的患者进行评分量化。
38例有症状的胃食管反流病或十二指肠胃食管反流患者以及12例无症状对照者，根据pH测量和胆汁测量进行分类，接受了内镜检查。从正常黏膜取6块组织活检进行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（每位患者至少测量100个横断面）。
22例胃食管反流病患者的宏观黏膜正常，但组织学检查发现，5例糜烂性胃食管反流病患者有轻度食管炎，1例有中度食管炎。7例十二指肠胃食管反流患者的黏膜正常，而3例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，所有对照者的细胞间隙扩张均小于1.69微米。每位有症状患者的平均细胞间隙扩张值和最大细胞间隙扩张平均值至少是对照者的三倍或更多（P<0.001）。糜烂性和非糜烂性食管炎之间未观察到统计学差异。
细胞间隙扩张是胃食管反流病、十二指肠胃食管反流和非糜烂性反流病损伤的极其敏感的标志物，是迄今为止报道的非糜烂性反流病损伤评估的最合适标志物。平均细胞间隙扩张0.74微米可作为损伤的临界评分。在单纯酸反流和混合酸反流之间，细胞间隙扩张评分在数量或质量上均未发现差异。
