Esophageal sensitivity to acid in patients with Barrett's esophagus is not related to preserved esophageal mucosal integrity
| Autor: | Arjan Bredenoord, Joanne Verheij, Pim W. Weijenborg, A. J. P. M. Smout, K. K. Krishnadath, J. G. H. M. Bergman |
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| Přispěvatelé: | AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and Hepatology, CCA - Cancer Treatment and Quality of Life, CCA -Cancer Center Amsterdam, Pathology |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Esophageal Mucosa Physiology Gastroenterology Barrett Esophagus 03 medical and health sciences Esophagus 0302 clinical medicine Acid perfusion test Internal medicine Biopsy Humans Medicine Prospective Studies Prospective cohort study Aged medicine.diagnostic_test Ussing chamber Endocrine and Autonomic Systems business.industry Reflux Middle Aged medicine.disease humanities digestive system diseases medicine.anatomical_structure 030220 oncology & carcinogenesis Barrett's esophagus Gastroesophageal Reflux GERD Female 030211 gastroenterology & hepatology business |
| Zdroj: | Neurogastroenterology and motility, 29(7). Wiley-Blackwell |
| ISSN: | 1350-1925 |
| Popis: | Background Patients with Barrett's esophagus (BE) usually have severe gastroesophageal reflux. However, they often have surprisingly few reflux symptoms. We hypothesized that BE patients are less sensitive to acid than gastroesophageal reflux disease (GERD) patients without Barrett and that this is due to an unusual preservation of mucosal integrity of the squamous epithelium prohibiting transepithelial acid diffusion. Methods We prospectively analyzed esophageal sensitivity and esophageal mucosal integrity in GERD patients with and without BE and healthy subjects. An acid perfusion test was performed and mucosal integrity was assessed in vivo by electrical tissue impedance spectroscopy and ex vivo by Ussing chamber experiments with biopsy specimens. Key Results Gastroesophageal reflux disease patients with BE were less sensitive to acid than GERD patients without BE, but more sensitive to acid than healthy controls (time to perception Barrett's 14.0 minutes, GERD 4.6 minutes, controls 17.5 minutes). However, extracellular impedance (6.2 and 5.7 vs 8.4×103 Ω/m) and transepithelial resistance (94.0 and 89 vs 118 Ω/cm2) was similar in BE and GERD patients and significantly lower than in healthy subjects. Transepithelial fluorescein flux was equally increased in GERD patients with and without BE (1.6 and 1.7×103 vs 0.6×103 nmol/cm2/h). Conclusions & Inferences Esophageal hypersensitivity to acid is less pronounced in BE patients than in GERD patients without Barrett. However, mucosal integrity of the squamous epithelium is equally impaired in GERD patients with and without Barrett, indicating that factors other than esophageal mucosal barrier integrity explain the difference in acid sensitivity between those with BE and those without. |
| Databáze: | OpenAIRE |
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