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Esophageal sensitivity to acid in patients with Barrett's esophagus is not related to preserved esophageal mucosal integrity
Author(s) -
Weijenborg P. W.,
Smout A. J. P. M.,
Krishnadath K. K.,
Bergman J. G. H. M.,
Verheij J.,
Bredenoord A. J.
Publication year - 2017
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13066
Subject(s) - gerd , medicine , gastroenterology , esophagus , reflux , ussing chamber , barrett's esophagus , nerd , biopsy , esophageal ph monitoring , esophageal disease , disease , adenocarcinoma , cancer , secretion
Background Patients with Barrett's esophagus ( BE ) usually have severe gastroesophageal reflux. However, they often have surprisingly few reflux symptoms. We hypothesized that BE patients are less sensitive to acid than gastroesophageal reflux disease ( GERD ) patients without Barrett and that this is due to an unusual preservation of mucosal integrity of the squamous epithelium prohibiting transepithelial acid diffusion. Methods We prospectively analyzed esophageal sensitivity and esophageal mucosal integrity in GERD patients with and without BE and healthy subjects. An acid perfusion test was performed and mucosal integrity was assessed in vivo by electrical tissue impedance spectroscopy and ex vivo by Ussing chamber experiments with biopsy specimens. Key Results Gastroesophageal reflux disease patients with BE were less sensitive to acid than GERD patients without BE , but more sensitive to acid than healthy controls (time to perception Barrett's 14.0 minutes, GERD 4.6 minutes, controls 17.5 minutes). However, extracellular impedance (6.2 and 5.7 vs 8.4×10 3 Ω/m) and transepithelial resistance (94.0 and 89 vs 118 Ω/cm 2 ) was similar in BE and GERD patients and significantly lower than in healthy subjects. Transepithelial fluorescein flux was equally increased in GERD patients with and without BE (1.6 and 1.7×10 3 vs 0.6×10 3 nmol/cm 2 /h). Conclusions & Inferences Esophageal hypersensitivity to acid is less pronounced in BE patients than in GERD patients without Barrett. However, mucosal integrity of the squamous epithelium is equally impaired in GERD patients with and without Barrett, indicating that factors other than esophageal mucosal barrier integrity explain the difference in acid sensitivity between those with BE and those without.