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

• Published in: Digestive diseases and sciences Vol. 67; no. 5; pp. 1773 - 1782
• Main Authors: Mutha, Pritesh R., Fasullo, Matthew, Chu, Shijian, Schubert, Mitchell L., Zfass, Alvin, Cooper, Patricia, Gill, Mankanchan, Kang, Le, Vaezi, Michael, Wildhorn, Stu, Slaughter, Chris, Shah, Tilak
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2022; Springer Nature B.V
• Subjects: Biochemistry; Biopsy; Disease; Electric Impedance; Endoscopy; Esophagoscopy; Esophagus; Fluoresceins; Gastroenterology; Gastroesophageal Reflux; Hepatology; Humans; Lasers; Medical diagnosis; Medicine; Medicine & Public Health; Microscopy; Oncology; Original Article; Patients; Permeability; Prospective Studies; Transplant Surgery; Gastroesophageal reflux; Microscopy, Confocal; Barrett esophagus; Diagnostic technique, Digestive system; Electric impedance
• ISSN: 0163-2116; 1573-2568; 1573-2568
• DOI: 10.1007/s10620-021-06980-w

Introduction Epithelial barrier function (EBF) disruption is a key mechanism underlying gastroesophageal reflux disease (GERD). Our aim was to assess whether two novel technologies, probe-based confocal laser endomicroscopy (pCLE) and mucosal integrity testing (MIT), could assess EBF. Methods We prospectively enrolled patients undergoing upper endoscopy for refractory GERD or non-GERD conditions. Patients underwent esophagogastroduodenoscopy, pCLE, MIT, esophageal biopsy at 2 cm and 6 cm above the esophagogastric junction, and wireless pH testing. To assess EBF in vitro, biopsies were mounted in a mini-Ussing chamber, 1 ml of fluorescein was instilled on the mucosal side, and concentration of fluorescein on the serosal side was measured at 3 h. Results We enrolled 54 subjects (28 GERD, 26 non-GERD based on Lyon consensus criteria). In vivo permeability assessed by pCLE did not differ significantly between GERD vs. non-GERD patients and did not correlate with in vitro permeability. Mean MIT at 2 cm was lower in GERD compared to non-GERD (1914 vs. 3727 ohms). MIT correlated inversely with in vitro permeability at 2 cm and at 6 cm. Using a predictive model that used slope and intercept of MIT at 2 cm and 6 cm, sensitivity and specificity of MIT at identifying GERD was 76% and 72%, respectively. Conclusion pCLE did not differentiate GERD vs non-GERD and did not correlate with EBF measured in vitro. MIT, on the other hand, may be more promising as it differentiated GERD vs non-GERD and correlated with EBF measured in vitro.