الفهرس 
Gastroesophageal Reflux Disease (GERD)Only 14 pages are availabe for public view
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Abstract
Gastroesophageal reflux disease (GERD) has a global impact on health and
quality of life, affecting much of the world’s population. Gastroesophageal reflux
disease (GERD) develops when the reflux of gastric contents into the esophagus
leads to troublesome symptoms and/or complications and is the most common
chronic upper digestive disorder encountered by the gastroenterologist. Typical
GERD is defined by the presence of troublesome heartburn with/without
regurgitation.
Based on endoscopic findings GERD is differentiated in erosive (erosive
reflux disease or ERD), non-erosive reflux disease (NERD) and Barrett’s
esophagus (BE). ERD is characterized by endoscopic visible breaks of
esophageal mucosa integrity and classified according to various endoscopic
classifications, most recently the Los Angeles classification. However, two thirds
of patients with typical GERD symptoms do not exhibit visible mucosal changes
in conventional esophagogastroduodenoscopy (EGD) and are thus diagnosed as
having NERD.
Frequent histological changes as basal cell hyperplasia, elongation of the
papilla, inflammatory infiltrates and dilatation of the intercellular spaces are
observed in the distal esophagus of patients with both ERD and NERD.
Dilations of the intercellular spaces (ICS) are characteristic changes of
the esophageal mucosa of patients with ERD and NERD. ICS were described by
various others using electron microscopy and are even characterized by light
microscopy. This feature is being more widely
proposed as an additional morphological feature of acid induced damage
to the squamous epithelium. The widened ICS are supposed to permit the
diffusion of molecules to the lamina propria where sensory nerve endings are
located Therefore, ICS dilation even in the absence of endoscopically visible
Summary and Conclusion
79
mucosal damage may explain the occurrence of symptoms in patients with
NERD.
The integrity of epithelial surfaces is based on various cell-cell contacts
that provide the structural basis for barrier function by regulating the diffusion of
molecules and sorting of transmembrane proteins to apical and basolateral
surfaces. Tight junctions, adherens junction and desmosomes are the three major
structural units mediating barrier and sorting function.
At least 19 claudins have been found in the esophageal mucosa, but
claudin 1 and 4 are the most prominent. The structure of claudin based tight
junctions is yet to be fully resolved, but the primary role of claudins seems to be
related to the regulation of paracellular selectivity to small ions.
The heterologous expression in monolayers of the majority of claudin
isoforms leads to an experimental increase of the transepithelial electrical
resistance (TER), predominantly due to a selective decrease in cation
permeability.
In addition to the more apically orientated tight junction, an intact
adherens junction is also required for integrity of the epithelial barrier. The
adherens junction performs important roles in cell-cell adhesion and regulation
of the actin cytoskeleton. Cadherins, especially E-cadherin, are the major protein
components of the adherens junction. They initiate cellular contacts through
pairing between cadherins on opposing cells. They can also bind to cytoplasmic
proteins (catenins) which locally regulate actin cytoskeleton organization,
cadherin stability, and intracellular signaling pathways that control gene
transcription.
We aimed to study the immunohistochemical expression of Claudin-1 and
E-cadherin in patients with gastroesophageal reflux disease
Summary and Conclusion
80
Summary of our results:
• As regard age and sex, there was an insignificant difference between
Erosive and NERD group.
• As regard type in erosive group, type A was 11 (52.4%), B was 8
(38.1%), C was 2 (9.5%).
• According to Claudin-1, epithelium expression was positive in
11(52.4%) in Erosive group and 9(42.9%) in NERD group. There was
no significant difference between both groups as regard epithelium
expression, Localization, Pattern, H-Score. Regarding sub epithelium,
All cases were negative.
• According to E-cadherin, epithelium expression was positive in
17(81.0%) in Erosive group and 19(90.5%) in NERD group. There was
no significant difference between both groups as regard epithelium
expression, and H-Score. As regard epithelium Localization, the Pattern
was significant difference between both groups. Regarding sub
epithelium, All cases were negative.
• There was no significant relation between Claudin-1 (H-Score) and sex
in both groups Erosive and NERD groups. There was no significant
relation between Claudin-1 (H-Score) and type in erosive group.
• There was an insignificant correlation between Claudin-1 (H-Score) and
Age in both Erosive and NERD group.
• There was an insignificant relationship between E-cadherin (H-Score)
and Sex in both Erosive and NERD group. There was no significant
relation between E-cadherin (H-Score) and type in erosive group.
• There was an insignificant correlation between E-cadherin (H-Score)
and Age in both Erosive and NERD group.