Franchi Alessandro, Brogelli Beatrice, Massi Daniela, Santucci Marco, De Campora Enrico, Gallo Oreste
Department of Human Pathology and Oncology, University of Florence, Viale G.B. Morgagni 85, 50134, Firenze, Italy,
Eur Arch Otorhinolaryngol. 2007 Aug;264(8):907-11. doi: 10.1007/s00405-007-0295-z. Epub 2007 Apr 14.
Gastroesophageal reflux disease (GERD) can be associated with ear, nose, and throat signs and symptoms, a condition often referred to as laryngopharyngeal reflux (LPR). However, the morphologic alterations of laryngeal mucosa associated with LPR are currently poorly understood. Since the dilation of intercellular spaces (DIS) between squamous epithelial cells is considered a morphologic marker of acid damage to esophageal mucosa in GERD, we evaluated whether similar changes can be detected in the laryngeal epithelium of patients affected by LPR. The study group included 15 patients affected by LPR and 7 normal controls, who underwent laryngeal biopsies at the interarytenoid area. Specimens were routinely processed for light microscopic and ultrastructural examination. The intercellular spaces were measured in electron microscopy images using a computer assisted morphometric system. Ultrastructural analysis demonstrated an irregular intercellular space dilation in specimens from the group of patients with LPR. Another ultrastructural abnormality observed in a minority of patients was the presence of numerous cytoplasmic vacuoles. Computer assisted morphometric analysis demonstrated that the intercellular space between squamous cells was significantly wider in patients with LPR than in control subjects (411.7 nm +/- 188.6 SD vs. 155.8 nm +/- 56.4 SD, P = 0.003). These data indicate that ultrastructural evidence of DIS of epithelial cells may be a morphologic marker of acid reflux, as already described in esophageal mucosa. If this result will be confirmed in larger series it may provide a useful diagnostic tool for the identification of LPR.
胃食管反流病（GERD）可能与耳、鼻、喉的体征和症状相关，这种情况通常被称为喉咽反流（LPR）。然而，目前对与LPR相关的喉黏膜形态学改变了解甚少。由于鳞状上皮细胞间细胞间隙扩张（DIS）被认为是GERD中食管黏膜酸损伤的形态学标志物，我们评估了在受LPR影响的患者喉上皮中是否能检测到类似变化。研究组包括15例受LPR影响的患者和7例正常对照，他们在杓间区进行了喉活检。标本常规处理用于光镜和超微结构检查。使用计算机辅助形态测量系统在电子显微镜图像中测量细胞间隙。超微结构分析显示LPR患者组标本中存在不规则的细胞间隙扩张。在少数患者中观察到的另一种超微结构异常是存在大量细胞质空泡。计算机辅助形态测量分析表明，LPR患者鳞状细胞间的细胞间隙明显宽于对照组（411.7 nm±188.6 SD vs. 155.8 nm±56.4 SD，P = 0.003）。这些数据表明，上皮细胞DIS的超微结构证据可能是酸反流的形态学标志物，正如在食管黏膜中已描述的那样。如果这一结果在更大系列中得到证实，则可能为LPR的识别提供一种有用的诊断工具。
