title: Reversibility of GERD ultrastructural alterations and relief of symptoms after omeprazole treatment.
abstract: 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.
authors.affiliation: Dipartimento di Medicina Interna e Gastroenterologia, Sezione di Anatomia Patologica, Università di Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Calabrese
authors.forename: Mauro
authors.initials: M
authors.lastname: Bortolotti
authors.forename: Anna
authors.initials: A
authors.lastname: Fabbri
authors.forename: Alessandra
authors.initials: A
authors.lastname: Areni
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cenacchi
authors.forename: Carlo
authors.initials: C
authors.lastname: Scialpi
authors.forename: Mario
authors.initials: M
authors.lastname: Miglioli
authors.forename: Giulio
authors.initials: G
authors.lastname: Di Febo
mesh_terms: 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*
chemical_list: D009853:Omeprazole