Microscopic measurement of intercellular space of squamous epithelium in lower part esophagus of patients with gastro-esophageal reflux disease

Abstract

Objective To evaluate the clinical significance of intercellular space diameters （ISD）of squamous epithelium by light microscopy （LM） in lower esophagus of erosive reflux esophagitis （ERD）,non-erosive reflux disease （ NERD）, Barrett esophagus （BE） and healthy controls. Methods A total of 21 ERD and 21 NERD patients with reflux symptoms and confirmed with 24-hour esophageal pH monitoring, 13 BE patients diagnosed by gastroscopy and biopsy, and 20 other healthy controls were enrolled in the study.Samples of ERD, NERD and control group were collected at 2 cm above dentate line, and made HE slides in the conventional way. Images for measurement of ICS were acquired with oil lens （ × 1000）. ICS of squamous epithelium was quantitatively measured by computer-assisted morphometry. Ten cells were taken for each sample, 10 consecutive ISD for each cell, i.e. 100 ISD for each subject. Mean ISD was calculated.Results Mean ISDs by LM in control, BE, ERD, and NERD groups were 0. 59, 0. 99, 1.29 and 1.06 μm, respectively. The mean ISDs in BE, ERD, and NERD group were much greater than that in control （P〈0. 05）. The mean, maximal and minimal ISDs of group ERD were greater than those of NERD and BE （P = 0. 000）. However, the ISDs of NERD and BE are of no significant difference （ P 〉 0. 05 ）. The cut-off value of mean ISD for diagnosis of gastro-esophageal reflux disease （GERD） was 0. 85 μm. Diagnostic sensitivity and specificity for ERD, NERD and BE were 89. 1% and 100. 0%, with reference to clinical symptoms, endoscopy and ISDs above the cut-off value. Conclusion Larger ISDs in lower esophagus by using LM will be found in all subgroups of GERD, including ERD, NERD and BE. Increased ISDs may be one of the markers for diagnosis of ERD, NERD and BE. Key words: Gastroesophageal reflux; Microscopy; Dilated intercellular space; Erosive reflux disease; Non erosive reflux disease; Barrett esophagus