title: Oesophageal mucosal intercellular space diameter and reflux pattern in childhood erosive and non-erosive reflux disease.
abstract: OBJECTIVE
  We sought to compare intercellular space diameter in children with non-erosive and erosive reflux disease, and a control group. We also aimed to characterize the reflux pattern in erosive and non-erosive reflux disease patients, and to explore the relationship between intercellular space diameter values and reflux parameters.
  
  
  METHODS
  Twenty-four children with non-erosive reflux disease, 20 with erosive reflux disease, and 10 controls were prospectively studied. All patients and controls underwent upper endoscopy. Biopsies were taken at 2-3 cm above the Z-line, and intercellular space diameter was measured using transmission electron microscopy. Non-erosive and erosive reflux disease patients underwent impedance-pH monitoring.
  
  
  RESULTS
  Mean intercellular space diameter values were significantly higher in both non-erosive (0.9 ± 0.2 μm) and erosive reflux disease (1 ± 0.2 μm) compared to controls (0.5 ± 0.2 μm, p<0.01). No difference was found between the two patient groups. Acid exposure time, the number of acid, weakly acidic and weakly alkaline reflux events did not differ between the two patient groups. No difference was found in the mean intercellular space diameter between non-erosive reflux disease children with and without abnormal acid exposure time (1 ± 0.3 vs. 0.9 ± 0.2 μm). No correlation was found between any reflux parameter and intercellular space diameter values.
  
  
  CONCLUSIONS
  Dilated intercellular space diameter seems to be a useful and objective marker of oesophageal damage in paediatric gastro-oesophageal reflux disease, regardless of acid exposure. In childhood, different gastro-oesophageal reflux disease phenotypes cannot be discriminated on the basis of reflux pattern.
authors.affiliation: Division of Pediatric Gastroenterology and Hepatology, Sapienza University of Rome, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Mancini
authors.forename: Mentore
authors.initials: M
authors.lastname: Ribolsi
authors.forename: Massimo
authors.initials: M
authors.lastname: Gentile
authors.forename: Gianluigi
authors.initials: G
authors.lastname: de'Angelis
authors.forename: Barbara
authors.initials: B
authors.lastname: Bizzarri
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Lindley
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
authors.forename: Michele
authors.initials: M
authors.lastname: Cicala
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Borrelli
mesh_terms: D000293:Adolescent; D001706:Biopsy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology* / Q000503:physiopathology; D005110:Extracellular Space; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D046529:Microscopy, Electron, Transmission; D009092:Mucous Membrane / Q000473:pathology; D011446:Prospective Studies