ULOGA E-CADHERINA U RANOM PREPOZNAVANJU OŠTEĆENJA SLUZNICE JEDNJAKA U GERB-u

CILJ: Pokušati utvrditi rana oštećenja sluznice jednjaka u vidu proširenja međustaničnih prostora (DIS) epitela distalnoga jednjaka pomoću imunohistokemijskog bojanja na transmembranske proteine. ISPITANICI I METODE: Presječno istraživanje provedeno na 15 ispitanika s refluksnim simptomima. Probir je izvršen na temelju GerdQ upitnika. Ključni podatci prikupljeni su videoendoskopijom, biopsijom i patohistološkom analizom uzoraka. Svim ispitanicima uzeta su po 4 uzorka sluznice distalnog jednjaka. Korišteno je imunohistokemijsko bojanje na transmembranske proteine e-cadherin i ß-catenin. Intezitet transmebranske obojenosti prihvaćen je kao pokazatelj kontinuiteta epitela, a time i proširenja međustaničnih prostora. REZULTATI: Među ispitanicima nije dokazan DIS. Dobivena je kod svih (100%) jaka transmembranska obojenost, kao neupitan znak očuvanosti kontinuiteta epitela. Manje od 50% ispitanika imalo je patohistološke promjene koje se mogu povezati s refluksom, tj. 46.7% je imalo hiperplaziju bazalnih stanica epitela i infiltraciju upalnim stanicama, a samo 20% izduženje stromalnih papila. ZAKLJUČCI: Imunohistokemijskim bojanjem na transmebranske proteine nije dokazano proširenje međustaničnih prostora, a i ostale histološke promjene zabilježene su samo u manjeg broja ispitanika. Sve to umanjuje vrijednost ove dijagnostike u endoskopski negativnoj fazi bolesti, daje prednost simptomatskom liječenju i ambulantnom praćenju bolesnika.OBJECTIVE: To determine the early esophageal mucosis changes manifested as dilatation of intercellular space (DIS) of distal esophageal epitelium by immunohistochemical staining of transmembrane proteins. METHODS: A cross - sectional study that enrolled 15 respondents with reflux symptoms. Screening was based on GerdQ questionnary. Key data were obtained by videoendoscopy, biopsy and patohistological sample analysis. 4 distal esophagus mucosis samples were taken from all respondents. Imunohistological staining of transmembrane proteins e-cadherin and β-catenin was used. The intensity of transmembrane staining was accepted as an indicator of the continuity of the epithelium, as well as dilatation of intercellular spaces. RESULTS: There was no evidence of DIS among the respondents. As indisputable sign of preservation of the continuity of the epithelium, strong transmembrane staining resulted in all (100%) respondents. Less than 50% of the respondents had patohistological changes that could be associated with reflux, 46.7% had basal epitel cell hiperplasia and infiltration of inflammatory cells, and only 20% of respondents had elongation of stromal papillae. CONCLUSIONS: Dilatation of intercellular space was not proven by immunohistochemical staining of transmembrane proteins, and the other histological changes were recorded with a smaller number of respondents. All this reduces the value of this particular diagnostic procedure in the endoscopic negative stage of the disease, and gives priority to symptomatic treatment, as well as ambulatory follow up of the patients