Dilated intercellular spaces as markers of reflux disease: histology, semiquantitative score and morphometry upon light microscopy

Digestion. 2001;64(1):1-8. doi: 10.1159/000048833.


Background and aims: A recent electron microscopy study suggested that dilated intercellular spaces (DIS) are specific for acid reflux-damaged esophageal epithelium. Electron microscopy is, however, expensive and difficult to apply to routine biopsies. The aims of this study are to establish a method for assessing DIS on light microscopy of esophageal biopsies and to estimate its association with current clinicopathological parameters of esophagitis.

Materials and methods: 21 patients with reflux symptoms were investigated. Light microscopy biopsies were assessed for DIS size by a semiquantitative method and computer-assisted, static morphometry. A DIS score accounting for DIS size and distribution was assigned to each patient and its association with 30 clinicopathological variables investigated by univariate and multivariate logistic regression.

Results: Both the semiquantitative method and static morphometry identified 4 different classes of DIS size. The DIS score was significantly and independently associated with the esophageal symptoms score, the histological score of esophagitis and the relevant morphometry data.

Conclusions: DIS may be efficiently assessed during light microscopy of routine esophageal biopsies. Since correlation with both the histology and the symptoms of esophagitis, the DIS score may be considered a novel parameter of esophagitis and is suggested for the routine evaluation of esophageal biopsies in patients with reflux disease.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Cell Count
  • Clinical Laboratory Techniques
  • Diagnosis, Computer-Assisted / methods
  • Esophagoscopy
  • Esophagus / pathology
  • Esophagus / ultrastructure*
  • Extracellular Space*
  • Female
  • Gastroesophageal Reflux / classification
  • Gastroesophageal Reflux / diagnosis*
  • Humans
  • Logistic Models
  • Male
  • Microscopy, Video / methods
  • Middle Aged
  • Mucous Membrane / pathology*
  • Mucous Membrane / ultrastructure*
  • Predictive Value of Tests