Article Text
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
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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