Mucosal integrity and sensitivity to acid in the proximal esophagus in patients with gastroesophageal reflux disease
| Autor: | Rene M. van den Wijngaard, Albert J. Bredenoord, Pim W. Weijenborg, Marius A. van den Bergh Weerman, André J.P.M. Smout, Joanne Verheij, Froukje B. van Hoeij |
|---|---|
| Přispěvatelé: | Tytgat Institute for Liver and Intestinal Research, Gastroenterology and Hepatology, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Pathology |
| Rok vydání: | 2016 |
| Předmět: |
Proximal esophagus
Adult Male medicine.medical_specialty Esophageal Mucosa Time Factors Physiology Biopsy Acid sensitivity Disease Gastroenterology Permeability Gastric Acid 03 medical and health sciences 0302 clinical medicine Heartburn Predictive Value of Tests Physiology (medical) Internal medicine Electric Impedance Medicine Humans In patient Prospective Studies Distal esophagus Aged Pain Measurement Hepatology business.industry Reflux Pain Perception Middle Aged digestive system diseases 030220 oncology & carcinogenesis Gastroesophageal Reflux 030211 gastroenterology & hepatology Female Esophagoscopy Hydrochloric Acid medicine.symptom business |
| Zdroj: | American journal of physiology. Gastrointestinal and liver physiology, 311(1), G117-G122. American Physiological Society |
| ISSN: | 1522-1547 0193-1857 |
| Popis: | Acid reflux episodes that extend to the proximal esophagus are more likely to be perceived. This suggests that the proximal esophagus is more sensitive to acid than the distal esophagus, which could be caused by impaired mucosal integrity in the proximal esophagus. Our aim was to explore sensitivity to acid and mucosal integrity in different segments of the esophagus. We used a prospective observational study, including 12 patients with gastroesophageal reflux disease (GERD). After stopping acid secretion-inhibiting medication, two procedures were performed: an acid perfusion test and an upper endoscopy with electrical tissue impedance spectroscopy and esophageal biopsies. Proximal and distal sensitivity to acid and tissue impedance were measured in vivo, and mucosal permeability and epithelial intercellular spaces at different esophageal levels were measured in vitro. Mean lag time to heartburn perception was much shorter after proximal acid perfusion (0.8 min) than after distal acid perfusion (3.9 min) ( P = 0.02). Median in vivo tissue impedance was significantly lower in the distal esophagus (4,563 Ω·m) compared with the proximal esophagus (8,170 Ω·m) ( P = 0.002). Transepithelial permeability, as measured by the median fluorescein flux was significantly higher in the distal (2,051 nmol·cm−2·h−1) than in the proximal segment (368 nmol·cm−2·h−1) ( P = 0.033). Intercellular space ratio and maximum heartburn intensity were not significantly different between the proximal and distal esophagus. In GERD patients off acid secretion-inhibiting medication, acid exposure in the proximal segment of the esophagus provokes symptoms earlier than acid exposure in the distal esophagus, whereas mucosal integrity is impaired more in the distal esophagus. These findings indicate that the enhanced sensitivity to proximal reflux episodes is not explained by increased mucosal permeability. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|