Correlation of Probe-Based Confocal Laser Endomicroscopy (pCLE) and Mucosal Integrity Testing (MIT) with Epithelial Barrier Function and Presence of Gastroesophageal Reflux Disease (GERD)

Author(s):  
Pritesh R. Mutha ◽  
Matthew Fasullo ◽  
Shijian Chu ◽  
Mitchell L. Schubert ◽  
Alvin Zfass ◽  
...  
2013 ◽  
Vol 1 (2) ◽  
pp. 1-6
Author(s):  
Anton Andreevich Shavrov ◽  
Igor Vitalevich Kirgizov ◽  
Andrey Alexandrovich Shavrov ◽  
Anastasiya Yurevna Kharitonova ◽  
Alexander Gavrilovich Talalaev ◽  
...  

2019 ◽  
Vol 91 (8) ◽  
pp. 4-11 ◽  
Author(s):  
I V Maev ◽  
D N Andreev ◽  
Yu A Kucheryavyy ◽  
R I Shaburov

Gastroesophageal reflux disease (GERD) is characterized by high morbidity and a significant decrease in the quality of life of patients, and is a major risk factor for esophageal adenocarcinoma. Nowadays, antisecretory therapy with proton pump inhibitors (PPI) is the "gold standard" of conservative treatment of GERD, but in some cases this therapy is unsuccessful. According to various studies, the prevalence of refractory GERD can reach 30-40%. The latest scientific data in the field of genetics and pathophysiology of GERD demonstrate that a disruption of the barrier function of the esophageal mucosa and an increase of its permeability can be the leading causes of refractoriness. Thus, the optimal therapy for patients with GERD should not only suppress the secretion of hydrochloric acid, but also restore the barrier function of the mucous membrane, providing an esophagoprotective effect. To achieve these goals, Alfasoxx was developed, which consists of a mixture of low molecular weight hyaluronic acid and low molecular weight chondroitin sulfate dissolved in a bioadhesive carrier (poloxamer 407). The clinical efficacy of this product has been confirmed by three prospective, randomized, placebo - controlled trials. Alfasoxx has a healing and restorative effect towards the esophageal epithelium and due to high ability for bioadhesion provides long - term protection of the mucous membrane of the esophagus. Combination therapy for GERD with the use of PPI and an esophagoprotector offers new perspectives for the treatment of patients with GERD.


2016 ◽  
Vol 31 (7) ◽  
pp. 2910-2917 ◽  
Author(s):  
Femke A. Mauritz ◽  
Nicolaas F. Rinsma ◽  
Ernest L. W. van Heurn ◽  
Cornelius E. J. Sloots ◽  
Peter D. Siersema ◽  
...  

2016 ◽  
Vol 150 (4) ◽  
pp. S278
Author(s):  
Tomoaki Matsumura ◽  
Makoto Arai ◽  
Mai Fujie ◽  
Hideaki Ishigami ◽  
Kenichiro Okimoto ◽  
...  

Author(s):  
M. B. Shcherbynina ◽  
N. E. Solovіovа ◽  
M. V. Patratiy

Gastroesophageal reflux disease (GERD) remains an urgent problem in clinical medicine. The search for ways of effective treatment leads to the need to set new accents in the multifactorial pathogenesis of the disease. According to current trends, special attention is paid to the epithelial barrier of the esophagus. The article presents considerations of the structure of the mucosal epithelial layer, the features of transport routes and intercellular interactions of the esophageal epithelium. Special attention is paid to the phenomenon of the Dilated Intercellular Spaces (DIS) and the syndrome of increased epithelial permeability (SІEP) at GERD. An interpretation of these concepts is given, their role in the implementation of inflammatory processes and the formation of clinical manifestations of the disease, such as heartburn and pain, is revealed. The data on the possible mechanisms of the formation of the DIS and SІEP phenomenon, methods of their diagnosis and aspects that are discussed in the scientific world are presented. The possibilities of cytoprotective therapy using alginate preparations have been shown. Among the alginates, available on the pharmaceutical market of Ukraine, the pharmacological line Gaviscon® (LLC Reckitt Benckiser Ukraine, Great Britain) is presented. The results of experimental studies with the use of the latest technologies, and data from randomized clinical trials confirming the alginates’ clinical efficacy, have been outlined. The phenomenon of DIS of the esophageal epithelium and SІEP for aggression factors is one of the leading links in GERD pathogenesis, in particular, its non‑erosive form, and to some extent determines the features of the clinical manifestations of the disease. Treatment of GERD with the use of alginates is logically justified, successfully used in clinical practice, and continues to be actively studied. The use of Gaviscon® products is expedient due to their unique mechanism of action to increase the resistance of the esophagus.  


2016 ◽  
Vol 311 (1) ◽  
pp. G117-G122 ◽  
Author(s):  
Froukje B. van Hoeij ◽  
Pim W. Weijenborg ◽  
Marius A. van den Bergh Weerman ◽  
René M. J. G. J. van den Wijngaard ◽  
J. Verheij ◽  
...  

Acid reflux episodes that extend to the proximal esophagus are more likely to be perceived. This suggests that the proximal esophagus is more sensitive to acid than the distal esophagus, which could be caused by impaired mucosal integrity in the proximal esophagus. Our aim was to explore sensitivity to acid and mucosal integrity in different segments of the esophagus. We used a prospective observational study, including 12 patients with gastroesophageal reflux disease (GERD). After stopping acid secretion-inhibiting medication, two procedures were performed: an acid perfusion test and an upper endoscopy with electrical tissue impedance spectroscopy and esophageal biopsies. Proximal and distal sensitivity to acid and tissue impedance were measured in vivo, and mucosal permeability and epithelial intercellular spaces at different esophageal levels were measured in vitro. Mean lag time to heartburn perception was much shorter after proximal acid perfusion (0.8 min) than after distal acid perfusion (3.9 min) ( P = 0.02). Median in vivo tissue impedance was significantly lower in the distal esophagus (4,563 Ω·m) compared with the proximal esophagus (8,170 Ω·m) ( P = 0.002). Transepithelial permeability, as measured by the median fluorescein flux was significantly higher in the distal (2,051 nmol·cm−2·h−1) than in the proximal segment (368 nmol·cm−2·h−1) ( P = 0.033). Intercellular space ratio and maximum heartburn intensity were not significantly different between the proximal and distal esophagus. In GERD patients off acid secretion-inhibiting medication, acid exposure in the proximal segment of the esophagus provokes symptoms earlier than acid exposure in the distal esophagus, whereas mucosal integrity is impaired more in the distal esophagus. These findings indicate that the enhanced sensitivity to proximal reflux episodes is not explained by increased mucosal permeability.


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