Oesophageal mucosal barrier: a key factor in the pathophysiology of non-erosive reflux disease (NERD) and a potential target for treatment

The stratified squamous epithelium of the oesophageal mucosa usually forms a tight protective barrier against noxious components of gastro-oesophageal reflux (such as acid and bile acids), a necessary function since the distal oesophageal mucosa is exposed to physiological reflux events, even in health. If there is a disruption to the effectiveness of this epithelial barrier (a so-called impairment of the mucosal integrity), its protective function is likely to be compromised, resulting in reflux-induced symptoms. Non-erosive reflux disease (NERD) is the phenotype of gastro-oesophageal reflux disease most frequently encountered in clinical practice, and may be more difficult to treat than erosive reflux disease.1 Contrary to endoscopic appearances, the oesophageal mucosa in patients with NERD is not completely normal and integrity of the mucosal barrier is impaired. This has been demonstrated by morphological and functional studies. In NERD, the basal layer of oesophageal mucosal epithelium demonstrates dilated intercellular spaces...

Source: Gut - April 7, 2014 Category: Gastroenterology Authors: Woodland, P., Sifrim, D. Tags: Commentary Source Type: research