Esophageal transmural potential difference in patients with symptomatic gastroesophageal reflux

Eckardt, V.; Adami, Bernd

doi:10.1007/bf01476571

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…We chose the rabbit esophagus for our model because (a) the absence of submucosal glands (12,19) enabled us to study the transport properties of the epithelium without interference by glandular secretion and (b) Chung et al (6) had defined the relationship between H+ efflux and changes in PD in this model. Initially, in vivo acid perfusion of the rabbit esophagus caused a transient increase in the esophageal PD (lumen electrically more negative), a finding similar to that reported in humans (14). Since the junctioin potential between HCI and a saline-perfused PD sensor produces a positive PD (20), this increase cannot be ascril)ed to a junctioni potential.…”

Section: Discussionsupporting

confidence: 67%

“…In the present study, we describe the physiologic alterations produced by H+ alone and with pepsin and correlate them with changes in morphology. In addition, since there has been renewed interest in the use of esophageal potential difference (PD)2 measure-ments for the detection of esophageal mucosal disease in man (13)(14)(15), we investigated the relationship between an altered in vivo PD and alterations in esophageal morphology and physiology.…”

Section: Introductionmentioning

confidence: 99%

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Pathophysiology of acute acid injury in rabbit esophageal epithelium.

Orlando¹,

Powell²,

Carney³

1981

J. Clin. Invest.

130

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A B S T R A C T To increase our understanding of the pathophysiology of reflux esophagitis, we sought the early sequence of changes in mucosal structure and function in acutely acid-damaged rabbit esophagus. Using a perfused catheter technique esophageal potential difference (PD) profiles were obtained in anesthetized rabbits before, during, and after perfusion of the lower one-half of the esophagus with phosphatebuffered saline or 80 mM HCI-80 mM NaCl. When acid perfusion reduced the lower esophageal PD by 40-50% or 80-100% of the initial values, the esophagus was removed, sectioned, and the mucosa studied with light microscopy, transmission electron microscopy, and Ussing chamber technique for evaluation of sodium and mannitol transport. The earlier stage of acid damage (PD 140-50%) was associated with reduced mucosal resistance from 2,180±+199 to 673±+157 ohm * cm2 and increased passive transport of sodium (0.10+0.06 to 1.82 +0.48 geq/h .cm2) and mannitol (0.008+0.003 to 0.051±0.012 MM/h -cm2) (P < 0.05).There was no significant change in short circuit current (0.35±0.05 to 0.35±0.04) or net sodium transport (0.32±0.06 to 0.37±0.12) at this stage, and the only morphologic finding was dilated intercellular spaces on electron microscopy. The later stage ofacid damage (PDJ80-100%) exhibited a further reduction in resistance to 299±65 ohm cm2 (P < 0.05), a finding now accompanied by a reduction in short circuit current (0.35±0.05 to 0.21±0.04 Aeq/h -cm2) and complete inhibition of net sodium transport (0.32±0.06 to 0.01 ±0.13) (P < 0.05). Morphologic studies at this time revealed cellular necrosis, edema, and vesicle formation in the stratum spinosum. Both gross mucosal changes and transmural necrosis were notably absent. When esophageal perfusion was performed with a combination of acid (80 mM HCG-80 mM NaCl) and pepsin (100 ,ug/ml), the morphologic and physiologic findings were essentially the same as with acid alone; however, the time of perfusion to reach either the 50 or 100%

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Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Pathophysiology of acute acid injury in rabbit esophageal epithelium.

Orlando¹,

Powell²,

Carney³

1981

J. Clin. Invest.

130

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“…This technique is useful to detect changes in the integrity of the mucosa of GERD patients with severe esophagitis but it fails in patients with mild esophagitis and NERD. [75][76][77][78] Moreover, according to Ohm's law (PD = I/R), the PD does not only reflect the integrity of the tissue, as changes in PD may also occur when changes in secretion arise. Then, TMPD is not a good tool for studying mucosal integrity in NERD patients or in refractory patients, in whom esophageal lesions are normally absent due to acid suppression therapy.…”

Section: Functional Evaluation Of Esophageal Mucosa Integritymentioning

confidence: 99%

Pathophysiology of gastro‐esophageal reflux disease: a role for mucosa integrity?

Farré

2013

Neurogastroenterology Motil

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“…However, more recent studies [21][22][23][24][25][26][27], 52 Scarpignato/Micali/Galmiche Transmucosal Potential Difference asan Index of Esophageal Mucosal Integrity [31], Four years later, the same team [23] reported a further refinement of the technique by introducing the Ringer washout of the esophagus in order to prevent or reduce the interference of junction, diffusion and/or streaming potential (see below).…”

Section: Esophageal Pdmentioning

confidence: 99%

“…Several investigators have measured transmucosal esophageal PD in patients with reflux esophagitis [21][22][23][24][25][26][27], Many of them found less negative PD values in patients with reflux esophagitis compared with healthy subjects, although two studies [22,25] reported higher (i.e. more negative) values (table 1).…”

Section: Esophageal Pd In Esophageal Diseasementioning

confidence: 99%

Transmucosal Potential Difference as an Index of Esophageal Mucosal Integrity

Scarpignato

Micali²,

Galmiche³

1995

Digestion

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All the epithelia lining the gastrointestinal (GI) tract, including that of the esophagus, exhibit a transmucosal electrical potential difference (PD). The luminal surface of the GI mucosa is indeed electrically negative when compared with the serosal one. Although it was initially felt that the body of the esophagus exhibits a PD near 0 or slightly positive, recent studies, using parenteral reference electrodes, have shown a negative PD of around -15 mV. Measurement of esophageal PD has been mainly used to locate both the lower and the upper esophageal sphincters but very rarely to evaluate esophageal mucosal integrity in clinical settings, most probably due to the difficulties encountered during measurement of mucosal PD. Reliable techniques to measure esophageal PD simultaneously with esophageal pressure or mucosal pH are now available. Application of these recently developed methodologies showed that measurement of esophageal PD during either manometry or endoscopy provides meaningful information about mucosal integrity. Indeed, tissue injury, either neoplastic or inflammatory, usually results in a less negative PD. In contrast, an abnormally high negative PD is very often observed in patients with columnar-lined lower esophagus. In patients with microscopic reflux esophagitis, PD exhibits less negative values which are significantly correlated with the degree of the mucosal damage. Normalization of the altered PD after either medical or surgical treatment makes it an additional parameter to evaluate the effect of a given therapy.

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Esophageal transmural potential difference in patients with symptomatic gastroesophageal reflux

Cited by 6 publications

References 21 publications

Pathophysiology of acute acid injury in rabbit esophageal epithelium.

Pathophysiology of acute acid injury in rabbit esophageal epithelium.

Pathophysiology of gastro‐esophageal reflux disease: a role for mucosa integrity?

Transmucosal Potential Difference as an Index of Esophageal Mucosal Integrity

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