title: Dilated intercellular spaces in eosinophilic esophagitis.
abstract: OBJECTIVE
  Dilated intercellular spaces (DIS) in the esophageal epithelium can be induced by acid and reduced by proton pump inhibitors (PPI), and are thus considered a marker of gastroesophageal reflux disease (GERD). Over the years, however, DIS have also been reported in esophagitis unrelated to GERD. Because DIS have never been formally measured in eosinophilic esophagitis (EoE), we aimed at detecting and measuring DIS in EoE before and after nutritional or pharmacological therapy.
  
  
  METHODS
  In 22 children with EoE, DIS were measured by morphometry and transmission electron microscopy (TEM), before and after treatment with topical steroids (n = 16) and/or exclusion diet (n = 13). A total of 30 children undergoing upper gastrointestinal endoscopy with biopsy for nonesophageal disorders acted as controls.
  
  
  RESULTS
  In controls, the mean (± standard deviation [SD]) number of esophageal eosinophils was 0.91 (± 0.47) and the mean DIS values were 0.62 (± 0.08) μm at morphometry and 0.33 (± 0.24) μm at TEM. In patients with EoE, the mean (± SD) number of esophageal eosinophils decreased from 31.8 (± 6.96) to 6.64 (± 5.01) (P < 0.0001), and the mean DIS values decreased from 2.26 (± 0.21) to 1.23 (± 0.20) μm at morphometry (P < 0.0001), and from 2.24 (± 0.28) to 0.98 (± 0.19) μm at TEM (P < 0.0001), respectively, before and after treatment.
  
  
  CONCLUSIONS
  DIS are a prominent morphological feature of EoE, in which they can be significantly reduced by an appropriate non-PPI therapy.
authors.affiliation: *Gastroenterology and GI Endoscopy Unit, University Department of Pediatrics, Children's Hospital †Department of Pathology II, Spedali Civili, Brescia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ravelli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Villanacci
authors.forename: Moris
authors.initials: M
authors.lastname: Cadei
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fuoti
authors.forename: Giada
authors.initials: G
authors.lastname: Gennati
authors.forename: Marianna
authors.initials: M
authors.lastname: Salemme
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057765:Eosinophilic Esophagitis / Q000473:pathology*; D004804:Eosinophils / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D005110:Extracellular Space; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009092:Mucous Membrane / Q000473:pathology*