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Oesophagitis
Oesophageal epithelial innervation in health and reflux oesophagitis
  1. M Newtona,
  2. M A Kamma,
  3. P O Soedionob,
  4. P Milnerb,
  5. W R Burnhamc,
  6. G Burnstockb
  1. aDepartment of Physiology, St Mark’s Hospital, Northwick Park, Watford Road, Harrow, Middlesex HA1 3UJ, UK, bAutonomic Science Institute, Royal Free Hospital School of Medicine, Roslind Hill Street, London NW3 2PF, UK, cDepartment of Gastroenterology, Havering Hospital’s NHS Trust, Waterloo Road, Romford RM7 OBE, UK
  1. Dr Kamm.

Abstract

BACKGROUND The response of the oesophagus to refluxed gastric contents is likely to depend on intact neural mechanisms in the oesophageal mucosa. The epithelial innervation has not been systematically evaluated in health or reflux disease.

AIMS To study oesophageal epithelial innervation in controls, and also inflamed and non-inflamed mucosa in patients with reflux oesophagitis and healed oesophagitis.

PATIENTS Ten controls, nine patients with reflux oesophagitis, and five patients with healed oesophagitis.

METHODS Oesophageal epithelial biopsy specimens were obtained at endoscopy. The distribution of the neuronal marker protein gene product 9.5 (PGP), and the neuropeptides calcitonin gene related peptide (CGRP), neuropeptide Y (NPY), substance P (SP), and vasoactive intestinal peptide (VIP) were investigated by immunohistochemistry. Density of innervation was assessed by the proportion of papillae in each oesophageal epithelial biopsy specimen containing immunoreactive fibres (found in the subepithelium and epithelial papillae, but not penetrating the epithelium).

RESULTS The proportion of papillae positive for PGP immunoreactive nerve fibres was significantly increased in inflamed tissue when compared with controls, and non-inflamed and healed tissue. There was also a significant increase in VIP immunoreactive fibres within epithelial papillae. Other neuropeptides showed no proportional changes in inflammation.

CONCLUSIONS Epithelial biopsy specimens can be used to assess innervation in the oesophagus. The innervation of the oesophageal mucosa is not altered in non-inflamed tissue of patients with oesophagitis but alters in response to inflammation, where there is a selective increase (about three- to fourfold) in VIP containing nerves.

  • gastro-oesophageal reflux
  • reflux oesophagitis
  • innervation
  • neuropeptides
  • inflammation

  • Abbreviations

    CGRP
    calcitonin gene related peptide
    GORD
    gastro-oesophageal reflux disease
    NPY
    neuropeptide Y
    PGP
    protein gene product 9.5
    SP
    substance P
    VIP
    vasoactive intestinal polypeptide
    PBS
    phosphate buffered saline
    FITC
    fluorescein isothiocyanate

    • https://doi.org/10.1136/gut.44.3.317

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    • Abbreviations

      CGRP
      calcitonin gene related peptide
      GORD
      gastro-oesophageal reflux disease
      NPY
      neuropeptide Y
      PGP
      protein gene product 9.5
      SP
      substance P
      VIP
      vasoactive intestinal polypeptide
      PBS
      phosphate buffered saline
      FITC
      fluorescein isothiocyanate
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