Reversibility of GERD ultrastructural alterations and relief of symptoms after omeprazole treatment.
BACKGROUND
Dilation of intercellular spaces (DIS) of human esophageal epithelium, evident at transmission electron microscopy (TEM), is an early marker of damage caused by gastroesophageal reflux, but its reversibility after therapy has not been investigated.


OBJECTIVE
To evaluate whether omeprazole can induce the healing of DIS.


METHODS
Thirty-eight symptomatic patients, 22 with nonerosive reflux disease (NERD) and 16 with erosive esophagitis (EE), classified on the basis of 24-h pH monitoring, were enrolled. During upper gastrointestinal endoscopy, six biopsies from apparently normal mucosa were taken within the lower 5 cm of the esophagus for histological and TEM analysis. One hundred computer measurements were taken on TEM photomicrographs of the specimens in each patient. After 3 months of omeprazole 40 mg/die a further endoscopy with biopsies was performed. In patients with persistent heartburn and/or incomplete ultrastructural recovery of esophageal epithelium, a new endoscopy was performed after 3 more months of treatment.


RESULTS
After 3 months of therapy, 35 patients (92.1%) showed a complete recovery of DIS and resolution of heartburn. Three patients required 3 more months of therapy because of an incomplete recovery of the epithelium correlated with sporadic heartburn. Healing of the mucosa was achieved in two patients, whereas one had an incomplete recovery of DIS with persistent heartburn.


CONCLUSIONS
Three and six months of omeprazole therapy led to a complete recovery of DIS in 92.1% and 97.4% of cases, respectively. No significant differences of DIS between NERD and EE were noted. Complete recovery of DIS was accompanied by regression of heartburn in all cases.
Calabrese
Carlo
C
Dipartimento di Medicina Interna e Gastroenterologia, Sezione di Anatomia Patologica, Università di Bologna, Italy.
Bortolotti
Mauro
M
Fabbri
Anna
A
Areni
Alessandra
A
Cenacchi
Giovanna
G
Scialpi
Carlo
C
Miglioli
Mario
M
Di Febo
Giulio
G
D000328:Adult; D001706:Biopsy; D004847:Epithelial Cells / Q000648:ultrastructure; D004941:Esophagitis / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D006356:Heartburn / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000648:ultrastructure; D009853:Omeprazole / Q000627:therapeutic use*
D009853:Omeprazole