Is the esophageal squamous epithelial barrier function impaired in patients with gastroesophageal reflux disease?

Background: A disturbed epithelial barrier Function has been promoted as on e factor in the pathogeneis of gastroesophageal reflux disease (GERD). Wr t herefore studied the effect of acid perfusion on the transmural potential d ifference (PD! of the distal esophagus in relation to onset of reflux sympt oms. Methods: PD was assessed during perfusion with saline and with 0.1 M H Cl in healthy controls (n = 17) and in GERD patients without (n = 15) or wi th esophagitis (n = 6) and in remission after a Fundoplication (n = 10). He artburn and other upper GI symptoms were recorded concomitantly. Endoscopy- negative patients were studied before and after omeprazole treatment. Resul ts: HCl perfusion induced more lumen-negative peak PD values in patients wi th active GERD, regardless of the presence or absence of esophagitis, than in healthy controls. After successful therapy, the PD response to acid perf usion equalled that of healthy subjects. Acid perfusion was associated with the onset of heartburn in most patients with active GERD but in none of th e healthy subjects, and less frequently after medical and surgical therapy. Conclusions: The epithelial permeability to hydrogen ions differs between healthy subjects and patients with active GERD. Effective treatment, such a s omeprazole or fundoplication, might improve the barrier function.