Mucosal barrier defects in gastric intestinal metaplasia: in vivo evaluation by confocal endomicroscopy.
BACKGROUND
Helicobacter pylori infection and intestinal metaplasia (IM) are associated with gastric cancer. An impaired gastric mucosal barrier could be involved in this carcinogenesis.


OBJECTIVE
To evaluate laser confocal laser endomicroscopy (CLE) for in vivo functional imaging of mucosal barrier defects in patients with IM.


METHODS
Prospective, controlled study.


METHODS
A tertiary-care academic center.


METHODS
This study involved patients with IM of the gastric mucosa who underwent CLE for surveillance.


METHODS
Specific IM mucosa and non-IM mucosa in patients were identified by CLE, and targeted biopsy samples were taken for histopathology and electron microscopy.


METHODS
Post-CLE assessment of paracellular fluorescein leakage was devised and validated by electron microscopy. We also evaluated the effect of H pylori eradication on the mucosal barrier.


RESULTS
Forty-two patients were included. Of non-IM samples, the paracellular permeability was significantly increased in H pylori-positive samples compared with H pylori-negative controls (54 ± 31% vs 3 ± 6%, P < .05). Of IM samples, the permeability was significantly increased in both H pylori-negative and H pylori-positive samples (67 ± 34% and 72 ± 28% vs 3 ± 6%, both P < .05). The results of post-CLE assessment correlated well with the electron microscopy findings (R(2) 0.834, P < .0001). After the eradication of H pylori, the paracellular barrier dysfunction of non-IM mucosa was significantly improved as shown by electron microscopy and CLE (both P < .001). However, there was no significant change in IM mucosa.


CONCLUSIONS
Single-center study.


CONCLUSIONS
CLE allows functional imaging of mucosal barrier defects. Gastric IM is associated with an impaired paracellular barrier irrespective of H pylori eradication.
Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
Rui
R
Ji
Xiu-Li
XL
Zuo
Tao
T
Yu
Xiao-Meng
XM
Gu
Zhen
Z
Li
Cheng-Jun
CJ
Zhou
Yan-Qing
YQ
Li
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001706:Biopsy; D016009:Chi-Square Distribution; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology* / Q000503:physiopathology*; D016481:Helicobacter Infections / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology* / Q000503:physiopathology*; D018613:Microscopy, Confocal; D008854:Microscopy, Electron; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010539:Permeability; D018709:Statistics, Nonparametric
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D000658:Amoxicillin; D017291:Clarithromycin; D009853:Omeprazole