title: Electron microscopic study of intercellular space: correlation analysis of bronchial asthma and gastroesophageal reflux disease.
abstract: OBJECTIVE
  Bronchial asthma (BA) is considered an extra-esophageal syndrome of gastroesophageal reflux disease (GERD) with poor pathophysiological background. We analyzed the correlation between GERD and BA, examining esophageal epithelium with transmission electron microscopy (TEM), along with clinical findings.
  
  
  METHODS
  BA patients of controlled and partly-controlled levels were enrolled in the study. A pulmonary and gastrointestinal (GI) questionnaire was given. Patients with no symptoms joined the control group. Esophageal mucosal tissue was taken by esophagogastroduodenoscopy from both groups and processed for TEM. Intercellular space (IS) was measured with an image analyzing program, 100 times for each patient.
  
  
  RESULTS
  The control (n=20) and BA (n=20) groups revealed no significant differences in baseline characteristics. All BA patients were using corticosteroid inhalers, with seven patients having a recent history of acute exacerbation. Patients with at least one GI symptom made up 70% (14/20) of the BA group, and heartburn and/or regurgitation were detected in 40% of patients. Endoscopic findings of GERD were mucosal breaks (n=3). The IS of the control group was 0.389±0.297 um, while the BA group was 0.806±0.556 um (P=0.001). The presence of GERD symptoms (P=0.306) and a history of recent asthma attacks (P=0.710) did not show significant differences.
  
  
  CONCLUSIONS
  The BA group showed a significant difference in the dilatation of IS compared to the control group, suggesting a higher prevalence of GERD in BA patients and a close pathophysiological correlation.
authors.affiliation: Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Korea.
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Park
authors.forename: Eun Joo
authors.initials: EJ
authors.lastname: Lee
authors.forename: Hoon Jai
authors.initials: HJ
authors.lastname: Chun
authors.forename: Bora
authors.initials: B
authors.lastname: Keum
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Kim
authors.forename: Yoon-Tae
authors.initials: YT
authors.lastname: Jeen
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.forename: Chang Duck
authors.initials: CD
authors.lastname: Kim
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Ryu
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: In
authors.forename: Chang-Sub
authors.initials: CS
authors.lastname: Uhm
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000473:pathology* / Q000503:physiopathology; D001706:Biopsy; D016022:Case-Control Studies; D004108:Dilatation, Pathologic; D016145:Endoscopy, Digestive System; D004947:Esophagus / Q000503:physiopathology / Q000648:ultrastructure*; D005110:Extracellular Space; D005260:Female; D005764:Gastroesophageal Reflux / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D009092:Mucous Membrane / Q000648:ultrastructure; D056910:Republic of Korea; D012129:Respiratory Function Tests; D011795:Surveys and Questionnaires