Oesophageal mucosal intercellular space diameter and reflux pattern in childhood erosive and non-erosive reflux disease. (I.F. 3.162)

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