title: Altered intercellular glycoconjugates and dilated intercellular spaces of esophageal epithelium in reflux disease.
abstract: OBJECTIVE
  The usefulness of histological diagnosis of gastroesophageal reflux disease (GERD) is limited by poor specificity or sensitivity of available diagnostic tools. Recently, ultrastructural morphometry showed interstitial space dilation (ISD) to be a reliable sign of reflux disease. Aims of this study were to (a) search for a light microscopy equivalent of ISD, (b) test its diagnostic value, and (c) look for a possible role of intercellular glycoconjugates in its genesis.
  
  
  METHODS
  Esophageal grasp biopsies were taken during endoscopy, 2-3 cm and 6-7 cm above the squamocolumnar junction, from patients under investigation for GERD symptoms. The biopsies were fixed in aldehyde solutions and embedded in resin for electron microscopy or in paraffin for routine histology, and the glycoconjugates underwent immunohistochemistry using 3-fucosyl-N-acetylactosamine antibodies.
  
  
  RESULTS
  Irregular intercellular space dilation was detected in the basal and prickle layers using both light and electron microscopy. Hematoxylin-eosin preparations showed ISD in 20 of 22 (90%) erosive esophagitis cases, 30 of 44 (68%) endoscopy negative GERD cases, and 1 of 12 (8%) controls, with good interobserver (K = 0.75) and bioptic site reproducibility. ISD correlated with loss or rearrangement of intercellular glycoconjugates of the overlying layers and with granulocyte (eosinophil and/or neutrophil) infiltration.
  
  
  CONCLUSIONS
  Light microscopy ISD is a suitable index of GERD. Alterations of intercellular glycoconjugates are likely to have a role in the genesis of ISD and GERD.
authors.affiliation: Department of Human Pathology, University of Pavia and IRCCS Policlinico San Matteo, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Solcia
authors.forename: L
authors.initials: L
authors.lastname: Villani
authors.forename: O
authors.initials: O
authors.lastname: Luinetti
authors.forename: E
authors.initials: E
authors.lastname: Trespi
authors.forename: E
authors.initials: E
authors.lastname: Strada
authors.forename: C
authors.initials: C
authors.lastname: Tinelli
authors.forename: R
authors.initials: R
authors.lastname: Fiocca
mesh_terms: D004947:Esophagus / Q000378:metabolism / Q000473:pathology / Q000648:ultrastructure*; D005110:Extracellular Space; D005764:Gastroesophageal Reflux / Q000378:metabolism* / Q000473:pathology*; D006001:Glycoconjugates / Q000378:metabolism*; D006801:Humans; D006863:Hydrogen-Ion Concentration
chemical_list: D006001:Glycoconjugates