title: Influence of reflux and central obesity on intercellular space diameter of esophageal squamous epithelium.
abstract: BACKGROUND
  While central obesity increases gastroesophageal reflux (GER) by mechanically disrupting the anti-reflux barrier, limited data exist on pathways by which central obesity may potentiate esophageal injury by non-mechanical means. Obesity has been associated with an impaired epithelial intestinal barrier.
  
  
  OBJECTIVE
  We aimed to assess the influence of central obesity and reflux on the squamous esophageal epithelial intercellular space diameter (ICSD).
  
  
  METHODS
  The ICSD was measured using electron microscopy in esophageal biopsies from individuals who underwent ambulatory pH monitoring and endoscopy. Anthropometric measurements were obtained on all participants. Participants were classified into four groups: with and without central obesity and reflux.
  
  
  RESULTS
  Sixteen individuals were studied with four in each study group. The mean ICSD was almost three-fold greater (p < 0.001) in the group with central obesity without reflux, compared to controls without central obesity and reflux. It was also comparable to the ICSD in groups with acid reflux only and those with both reflux and central obesity.
  
  
  CONCLUSIONS
  There is evidence of esophageal squamous ICSD increase in individuals with central obesity who do not have evidence of acid and nonacid reflux on ambulatory pH monitoring. This may reflect a mechanism by which central obesity potentiates reflux-induced esophageal injury and inflammation.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Blevins
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
authors.forename: Anamay N
authors.initials: AN
authors.lastname: Sharma
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Johnson
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Geno
authors.affiliation: Division of Gastroenterology, University of Calgary, Alberta, Canada.
authors.forename: Milli
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
authors.forename: Adil E
authors.initials: AE
authors.lastname: Bharucha
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Katzka
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
authors.forename: Prasad G
authors.initials: PG
authors.lastname: Iyer
keywords: Barrett’s; Central obesity; electron microscopy; esophageal reflux; intercellular dilation