Oesophageal mucosal intercellular space diameter and reflux pattern in childhood erosive and non-erosive reflux disease

BACKGROUND AND AIMS: We sought to compare intercellular space diameter in children with non-erosive and erosive reflux disease, and a control group. We also aimed to characterize the reflux pattern in erosive and non-erosive reflux disease patients, and to explore the relationship between intercellular space diameter values and reflux parameters.METHODS: Twenty-four children with non-erosive reflux disease, 20 with erosive reflux disease, and 10 controls were prospectively studied. All patients and controls underwent upper endoscopy. Biopsies were taken at 2-3cm above the Z-line, and intercellular space diameter was measured using transmission electron microscopy. Non-erosive and erosive reflux disease patients underwent impedance-pH monitoring.RESULTS: Mean intercellular space diameter values were significantly higher in both non-erosive (0.9±0.2μm) and erosive reflux disease (1±0.2μm) compared to controls (0.5±0.2μm, p<0.01). No difference was found between the two patient groups. Acid exposure time, the number of acid, weakly acidic and weakly alkaline reflux events did not differ between the two patient groups. No difference was found in the mean intercellular space diameter between non-erosive reflux disease children with and without abnormal acid exposure time (1±0.3 vs. 0.9±0.2μm). No correlation was found between any reflux parameter and intercellular space diameter values.CONCLUSIONS: Dilated intercellular space diameter seems to be a useful and objective marker of oesophageal damage in paediatric gastro-oesophageal reflux disease, regardless of acid exposure. In childhood, different gastro-oesophageal reflux disease phenotypes cannot be discriminated on the basis of reflux pattern