Electron microscopic changes in human oesophageal epithelium in oesophagitis

Abstract

At the ultrastructural level the inflamed oesophageal epithelium shows a variety of lesions. These include mitochondrial damage, intracellular oedema, membrane whorls and dilation of the endoplasmic reticulum and the appearance of keratohyaline and parakeratosis granules. The basement membrane shows changes ranging from thickening to areas of loss of continuity. There is an increase in the anchoring fibrils. The spaces between the cells are enlarged and contain varying amounts of debris rich in neutral mucosubstances. There are less membrane-coated granules in the inflamed epithelium than in the normal. The intra-epithelial intrusive cells demonstrated were lymphocytes and neutrophil polymorphs.

Dilated Intercellular Spaces as Markers of Reflux Disease: Histology, Semiquantitative Score and Morphometry upon Light Microscopy

“…DIS in esophageal samples have been described previously although their potential clinicopathological significance has only been investigated in part [2, 13, 14]. It has been experimentally proven that gastric acid reflux may damage the esophageal mucosa resulting in dilated extracellular spaces [15], as recently demonstrated on ultrastructural analysis in man [7].…”

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

“…Dilation of intercellular spaces (ISD) has been reported in electron microscopy investigations to be a specific change of acid-damaged esophageal epithelium, either in acute experiments on rabbits or in humans suffering from GERD [3,12,29]. Increased paracellular permeability to acid seems crucial in the pathogenesis of ISD, possibly through damage to epithelial cell membranes causing impaired sodium transport and water accumulation in the intercellular space [3,18,28].…”

Efficacy of Omeprazole for the Treatment of Symptomatic Acid Reflux Disease Without Esophagitis

“…The findings of this study are substantiated by those from experimental models. 44,45 Thus, the presence of dilated intercellular spaces induced by acid before any visible mucosal damage occurs suggests that these dilated spaces may be a very early step in the acid-damage cascade. The presence of dilated intercellular spaces in patients with GERD who have no macroscopic evidence of disease thus offers a possible explanation for the acute onset of symptoms during episodes of acid reflux through access of this acid to sensory neurons within the epithelium.…”