Mucosal integrity and sensitivity to acid in the proximal esophagus in patients with gastroesophageal reflux disease

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 ·m) compared with the proximal esophagus (8,170 ·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 intens...

Source: AJP: Gastrointestinal and Liver Physiology - June 30, 2016 Category: Gastroenterology Authors: van Hoeij, F. B., Weijenborg, P. W., van den Bergh Weerman, M. A., van den Wijngaard, R. M. J. G. J., Verheij, J., Smout, A. J. P. M., Bredenoord, A. J. Tags: NEUROGASTROENTEROLOGY AND MOTILITY Source Type: research