Intercellular space volume is mainly increased in the basal layer of esophageal squamous epithelium in patients with GERD.
OBJECTIVE
At present, the dilation of esophageal intercellular spaces (ICS) is considered an early morphologic marker of acid damage in patients with GERD. Nevertheless, previous electron microscopic (EM) studies had focused only on the suprabasal layer of squamous epithelium or did not nearly specify which layer of squamous epithelium was studied. Therefore, we aimed to assess the volumetric amount of the ICS in all layers of SE in patients with GERD.


METHODS
In this study, 48 patients were prospectively included (NERD = 18, ERD = 17; Barrett's esophagus = 5, controls = 8). All patients with ERD and NERD had typical reflux symptoms, as assessed by a valid GERD questionnaire. ICS volume was assessed by electron microscopy in the superficial, prickle cell, and basal layers of esophageal squamous epithelium using the method of Weibel.


RESULTS
ERD was associated with increased ICS volume in the basal layer (LA-A, p = 0.038; LA-B, p = 0.005) and prickle cell layer (LA-A, p = 0.006; LA-B, p = 0.007) as compared to controls. Comparisons between NERD and ERD patients revealed more dilated ICS in the basal layer (LA-B, p = 0.007), prickle cell layer (LA-A, p = 0.008; LA-B, p = 0.001) and superficial layer (LA-B, p = 0.018) in patients with ERD.


CONCLUSIONS
Not only the diameter but also the volume of the ICS is increased in patients with GERD. Furthermore, the dilation of ICS is present in all three layers of the SE, being more pronounced in the basal layer. These findings support the concept that the impairment of the esophagus begins in the deeper parts of the esophageal epithelium.
Department of Medicine I, University of Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany. helmut.neumann@uk-erlangen.de
Helmut
H
Neumann
Klaus
K
Mönkemüller
Lucía C
LC
Fry
Frank
F
Dombrowski
Doerthe
D
Kuester
Mike
M
Beyer
Peter
P
Malfertheiner
D001471:Barrett Esophagus / Q000473:pathology; D016022:Case-Control Studies; D004847:Epithelial Cells / Q000648:ultrastructure*; D004848:Epithelium / Q000473:pathology / Q000648:ultrastructure; D004947:Esophagus / Q000473:pathology* / Q000648:ultrastructure*; D005110:Extracellular Space; D005764:Gastroesophageal Reflux / Q000473:pathology*; D006801:Humans