Intraluminal pH and Goblet Cell Density in Barrett’s Esophagus
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- 作者：Dimitrios Theodorou (1)
Shahin Ayazi (1)
Steven R. DeMeester (1)
Joerg Zehetner (1)
Christian G. Peyre (1)
Kimberly S. Grant (1)
Florian Augustin (1)
Daniel S. Oh (1)
John C. Lipham (1)
Parakrama T. Chandrasoma (2)
Jeffrey A. Hagen (1)
Tom R. DeMeester (1) (3) - 关键词：Gastroesophageal reflux disease (GERD) ; Barrett’s esophagus ; Goblet cell ; pH gradient
- 刊名：Journal of Gastrointestinal Surgery
- 出版年：2012
- 出版时间：March 2012
- 年：2012
- 卷：16
- 期：3
- 页码：469-474
- 全文大小：257KB
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Shahin Ayazi (1)
Steven R. DeMeester (1)
Joerg Zehetner (1)
Christian G. Peyre (1)
Kimberly S. Grant (1)
Florian Augustin (1)
Daniel S. Oh (1)
John C. Lipham (1)
Parakrama T. Chandrasoma (2)
Jeffrey A. Hagen (1)
Tom R. DeMeester (1) (3)
1. Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
2. Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
3. 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA
文摘
Introduction Goblet cells in Barrett’s esophagus (BE) vary in their density within the Barrett’s segment. Exposure of Barrett’s epithelium to bile acids is a major stimulant for goblet cell formation. The dissociation of bile acids into forms that penetrate Barrett’s epithelium is known to be pH dependent. We hypothesized that variations in the esophageal luminal pH environment explains the variability in goblet cell density. The aim of this study was to correlate esophageal luminal pH with goblet cell density in patients with BE. Methods A customized six-sensor pH catheter was positioned with the most distal sensor in the stomach and the remaining sensors located 1?cm below and 1, 3, 5, and 8?cm above the upper border of the lower esophageal sphincter in five normal subjects and six patients with long-segment BE. The luminal pH was measured by each sensor for 24-h and expressed as median pH. Patients with BE had four quadrant biopsies at levels corresponding to the location of the pH sensors. Goblet cell density was graded from 0 to 3 based on the number per high-power field. Results In normal subjects, the median pH values recorded in the sensors within the lower esophageal sphincter (LES) and esophageal body were all above 5. In patients with BE, the median pH recorded by the sensor within the LES was 2.8 and increased progressively to 4.7 in the sensor at 8?cm above the LES. Goblet cell density was significantly lower in the distal Barrett’s segment exposed to a median pH of 2.2 and increased in the proximal Barrett’s segment exposed to a median pH of 4.4 (p--.003). Conclusion Patients with BE have a goblet cell gradient that correlates directly with an esophageal luminal pH gradient. This suggests that goblet cell differentiation is pH dependent and likely due to the effect of pH on bile acid dissociation.