Altered intercellular glycoconjugates and dilated intercellular spaces of esophageal epithelium in reflux disease

Background and aims: The usefulness of histological diagnosis of gastroesop hageal reflux disease (GERD) is limited by poor specificity or sensitivity of available diagnostic tools. Recently, ultrastructural morphometry showed interstitial space dilation (ISD) to be a reliable sign of reflux disease. Aims of this study were to (a) search for a light microscopy equivalent of LSD, (b) test its diagnostic value, and (c) look for a possible role of in tercellular glycoconjugates in its genesis. Methods: Esophageal grasp biops ies were taken during endoscopy, 2-3 cm and 6-7 cm above the squamocolumnar junction, from patients under investigation for GERD symptoms. The biopsie s were fixed in aldehyde solutions and embedded in resin for electron micro scopy or in paraffin for routine histology, and the glycoconjugates underwe nt immunohistochemistry using 3-fucosyl-N-acetylactosamine antibodies. Resu lts. Irregular intercellular space dilation was detected in the basal and p rickle layers using both light and electron microscopy. Hematoxylin-eosin p reparations showed ISD in 20 of 22 (90%) erosive esophagitis cases, 30 of 4 4 (68%) endoscopy negative GERD cases, and 1 of 12 (8%) controls, with good interobserver (K=0.75) and bioptic site reproducibility. ISD correlated wi th loss or rearrangement of intercellular glycoconjugates of the overlying layers and with granulocyte (eosinophil and/or neutrophil) infiltration. Co nclusions: Light microscopy ISD is a suitable index of GERD. Alterations of intercellular glycoconjugates are likely to have a role in the genesis of ISD and GERD.