[A study on the light microscopic measurement of intercellular space of squamous epithelium in lower-esophagus to diagnose gastroesophageal reflux disease].

OBJECTIVE: To evaluate the significance of dilated intercellular space (DIS) of squamous epithelium in lower-esophagus which was measured at light microscopy (LM) in the diagnosis of gastroesophageal reflux disease (GERD).
METHODS: This study was divided into two parts. The first part consists of 133 GERD patients with typical symptoms, including 75 erosive esophagitis (EE) and 58 non-erosive reflux disease (NERD); the second part consists of 25 healthy volunteers as control; ambulatory 24-hr esophageal pH monitoring, endoscopy and biopsies which were taken in lower esophagus were performed in all individuals. NERD patients with negative ambulatory 24-hr esophageal pH monitoring were undertaken PPI test. We selected 43 individuals randomly (4 control, 11 NERD and 28 EE) to measure the intercellular space diameter with LM and transmission electronic microscopy (TEM) simultaneously. All the samples were observed at immersion objective, taken pictures and make the scale at the same time; all the pictures were measured by the computer-assisted morphometry and in the samples for one case should be measured 100 points and then calculate the mean intercellular space diameter, while the TEM has the same procedures.
RESULTS: A total of 158 individuals (90 male, 68 female) were enrolled in this study. The mean intercellular space diameter with LM of the controls, the NERD and the EE patients were (0.61 +/- 0.10) microm, (1.12 +/- 0.61) microm and (1.30 +/- 0.19) microm, respectively, with significant differences between the control and NERD group, the control and EE group, the EE and NERD group (P < 0.05); the mean intercellular space diameter with LM of EE subgroup of LA-A, LA-B, LA-C, LA-D were (1.31 +/- 0.23) microm, (1.27 +/- 0.17) microm, (1.31 +/- 0.14) microm, (1.33 +/- 0.11) microm, respectively, without significant differences among every two subgroups (P > 0.05); NERD patients with positive and negative 24-hr ambulatory pH monitoring were 40 and 17 cases, and the mean intercellular space diameter with LM were (1.12 +/- 0.16) microm, (1.11 +/- 0.31) microm, respectively, without significant differences between them (P > 0.05); the cut-off value of mean intercellular space diameter with LM was 0.85 microm, if combination the clinical GERD symptom, endoscopy and 24-hr ambulatory pH monitoring as gold standard, its sensitivity was 95.5% and specificity was 100%; the intercellular space diameter of the controls, the NERD patients and the EE patients with TEM were (0.30 +/- 0.14) microm, (1.33 +/- 0.28) microm, (1.40 +/- 0.22) microm, respectively, with significant differences between the control and NERD group, the control and EE group (P < 0.05). It was significant correlation in intercellular space diameter between LM and TEM (r = 0.737, P = 0.000).
CONCLUSIONS: The intercellular space diameter of squamous epithelium in lower esophagus of GERD patients can make quantitative study with LM. It is significant correlation with TEM. DIS with LM is one of sensitive, specific and objective marker of GERD.