Dilated intercellular spaces: A major morphological feature of esophagitis

Alberto M. Ravelli, Vincenzo Villanacci, Nella Ruzzenenti, Piergiovanni Grigolato, Pamela Tobanelli, Catherine Klersy, Guido Rindi

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Dilated intercellular spaces (DIS) in the esophageal epithelium have been identified by electron microscopy as marker of acid reflux damage in experimental animals and adults with gastroesophageal reflux disease (GERD). We aimed to identify and quantify DIS by light microscopy in pediatric GERD and esophagitis. METHODS: We prospectively took esophageal biopsies in 70 consecutive pediatric patients, 48 of whom had GERD symptoms. On hematoxylin and eosin-stained sections esophagitis was scored histologically, and DIS were graded as 0 (absent), + (small and focal), ++ (moderate) or +++ (large and diffuse). A computerized image analysis identified total, cellular and nuclear areas and DIS were quantified as percentage of total minus cellular area. RESULTS: Forty of 48 GERD patients had histological esophagitis (33 G1, 4 G2, 3 G3, 1 of which with Barrett esophagus), and all 40 had DIS (33 +, 4 ++, 3 +++) with 100% interobserver agreement; 15 of 29 (55%) had abnormal pH study (reflux index, 5.7%-36%). In 30 patients the esophagus was histologically normal. DIS values were 2.21% ± 2.60% (range, 0.11%-12%) in patients with esophagitis and 0.44% ± 0.13% (0.2%-0.7%) in patients with normal histology (P <0.00001), with 0.71% bearing 70% sensitivity and 100% specificity for GERD versus controls. Five other children with esophagitis unrelated to GERD (eosinophilic, Candida, food allergy) also had DIS + to +++, and median DIS area was 5% (1.3%-12%). CONCLUSIONS: DIS can be detected and evaluated by light microscopy, and the image analysis used provides an objective quantification of DIS and supports the light microscopy evaluation. DIS are a morphological feature of GERD and esophagitis in infancy and childhood.

Original languageEnglish
Pages (from-to)510-515
Number of pages6
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume42
Issue number5
DOIs
Publication statusPublished - May 2006

Fingerprint

esophageal diseases
Esophagitis
intercellular spaces
Extracellular Space
gastroesophageal reflux
Gastroesophageal Reflux
light microscopy
Microscopy
Peptic Esophagitis
esophagus
Light
image analysis
Pediatrics
food allergies
Barrett Esophagus
Food Hypersensitivity
infancy
Hematoxylin
Eosine Yellowish-(YS)
Candida

Keywords

  • Esophagitis
  • Gastroesophageal reflux
  • Intercellular spaces

ASJC Scopus subject areas

  • Gastroenterology
  • Histology
  • Medicine (miscellaneous)
  • Food Science
  • Pediatrics, Perinatology, and Child Health

Cite this

Dilated intercellular spaces : A major morphological feature of esophagitis. / Ravelli, Alberto M.; Villanacci, Vincenzo; Ruzzenenti, Nella; Grigolato, Piergiovanni; Tobanelli, Pamela; Klersy, Catherine; Rindi, Guido.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 42, No. 5, 05.2006, p. 510-515.

Research output: Contribution to journalArticle

Ravelli, Alberto M. ; Villanacci, Vincenzo ; Ruzzenenti, Nella ; Grigolato, Piergiovanni ; Tobanelli, Pamela ; Klersy, Catherine ; Rindi, Guido. / Dilated intercellular spaces : A major morphological feature of esophagitis. In: Journal of Pediatric Gastroenterology and Nutrition. 2006 ; Vol. 42, No. 5. pp. 510-515.
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abstract = "OBJECTIVES: Dilated intercellular spaces (DIS) in the esophageal epithelium have been identified by electron microscopy as marker of acid reflux damage in experimental animals and adults with gastroesophageal reflux disease (GERD). We aimed to identify and quantify DIS by light microscopy in pediatric GERD and esophagitis. METHODS: We prospectively took esophageal biopsies in 70 consecutive pediatric patients, 48 of whom had GERD symptoms. On hematoxylin and eosin-stained sections esophagitis was scored histologically, and DIS were graded as 0 (absent), + (small and focal), ++ (moderate) or +++ (large and diffuse). A computerized image analysis identified total, cellular and nuclear areas and DIS were quantified as percentage of total minus cellular area. RESULTS: Forty of 48 GERD patients had histological esophagitis (33 G1, 4 G2, 3 G3, 1 of which with Barrett esophagus), and all 40 had DIS (33 +, 4 ++, 3 +++) with 100{\%} interobserver agreement; 15 of 29 (55{\%}) had abnormal pH study (reflux index, 5.7{\%}-36{\%}). In 30 patients the esophagus was histologically normal. DIS values were 2.21{\%} ± 2.60{\%} (range, 0.11{\%}-12{\%}) in patients with esophagitis and 0.44{\%} ± 0.13{\%} (0.2{\%}-0.7{\%}) in patients with normal histology (P <0.00001), with 0.71{\%} bearing 70{\%} sensitivity and 100{\%} specificity for GERD versus controls. Five other children with esophagitis unrelated to GERD (eosinophilic, Candida, food allergy) also had DIS + to +++, and median DIS area was 5{\%} (1.3{\%}-12{\%}). CONCLUSIONS: DIS can be detected and evaluated by light microscopy, and the image analysis used provides an objective quantification of DIS and supports the light microscopy evaluation. DIS are a morphological feature of GERD and esophagitis in infancy and childhood.",
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AU - Tobanelli, Pamela

AU - Klersy, Catherine

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AB - OBJECTIVES: Dilated intercellular spaces (DIS) in the esophageal epithelium have been identified by electron microscopy as marker of acid reflux damage in experimental animals and adults with gastroesophageal reflux disease (GERD). We aimed to identify and quantify DIS by light microscopy in pediatric GERD and esophagitis. METHODS: We prospectively took esophageal biopsies in 70 consecutive pediatric patients, 48 of whom had GERD symptoms. On hematoxylin and eosin-stained sections esophagitis was scored histologically, and DIS were graded as 0 (absent), + (small and focal), ++ (moderate) or +++ (large and diffuse). A computerized image analysis identified total, cellular and nuclear areas and DIS were quantified as percentage of total minus cellular area. RESULTS: Forty of 48 GERD patients had histological esophagitis (33 G1, 4 G2, 3 G3, 1 of which with Barrett esophagus), and all 40 had DIS (33 +, 4 ++, 3 +++) with 100% interobserver agreement; 15 of 29 (55%) had abnormal pH study (reflux index, 5.7%-36%). In 30 patients the esophagus was histologically normal. DIS values were 2.21% ± 2.60% (range, 0.11%-12%) in patients with esophagitis and 0.44% ± 0.13% (0.2%-0.7%) in patients with normal histology (P <0.00001), with 0.71% bearing 70% sensitivity and 100% specificity for GERD versus controls. Five other children with esophagitis unrelated to GERD (eosinophilic, Candida, food allergy) also had DIS + to +++, and median DIS area was 5% (1.3%-12%). CONCLUSIONS: DIS can be detected and evaluated by light microscopy, and the image analysis used provides an objective quantification of DIS and supports the light microscopy evaluation. DIS are a morphological feature of GERD and esophagitis in infancy and childhood.

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