Display options
Share it on

United European Gastroenterol J. 2016 Apr;4(2):177-83. doi: 10.1177/2050640615598426. Epub 2015 Jul 24.

Influence of reflux and central obesity on intercellular space diameter of esophageal squamous epithelium.

United European gastroenterology journal

Christopher H Blevins, Anamay N Sharma, Michele L Johnson, Deborah Geno, Milli Gupta, Adil E Bharucha, David A Katzka, Prasad G Iyer


  1. Department of Internal Medicine, Mayo Clinic, Rochester, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
  2. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA.
  3. Division of Gastroenterology, University of Calgary, Alberta, Canada.

PMID: 27087944 PMCID: PMC4804368 DOI: 10.1177/2050640615598426


BACKGROUND: While central obesity increases gastroesophageal reflux (GER) by mechanically disrupting the anti-reflux barrier, limited data exist on pathways by which central obesity may potentiate esophageal injury by non-mechanical means. Obesity has been associated with an impaired epithelial intestinal barrier.

OBJECTIVE: We aimed to assess the influence of central obesity and reflux on the squamous esophageal epithelial intercellular space diameter (ICSD).

METHODS: The ICSD was measured using electron microscopy in esophageal biopsies from individuals who underwent ambulatory pH monitoring and endoscopy. Anthropometric measurements were obtained on all participants. Participants were classified into four groups: with and without central obesity and reflux.

RESULTS: Sixteen individuals were studied with four in each study group. The mean ICSD was almost three-fold greater (p < 0.001) in the group with central obesity without reflux, compared to controls without central obesity and reflux. It was also comparable to the ICSD in groups with acid reflux only and those with both reflux and central obesity.

CONCLUSIONS: There is evidence of esophageal squamous ICSD increase in individuals with central obesity who do not have evidence of acid and nonacid reflux on ambulatory pH monitoring. This may reflect a mechanism by which central obesity potentiates reflux-induced esophageal injury and inflammation.

Keywords: Barrett’s; Central obesity; electron microscopy; esophageal reflux; intercellular dilation


  1. J Immunol. 2008 Apr 15;180(8):5653-61 - PubMed
  2. J Natl Cancer Inst. 2005 Jan 19;97(2):142-6 - PubMed
  3. Clin Gastroenterol Hepatol. 2014 Nov;12(11):1824-9.e1 - PubMed
  4. Cytokine. 2012 Aug;59(2):264-72 - PubMed
  5. Tissue Barriers. 2013 Oct 1;1(4):e25231 - PubMed
  6. Annu Rev Physiol. 2011;73:283-309 - PubMed
  7. Gastroenterology. 2010 Dec;139(6):1823-6 - PubMed
  8. Liver Int. 2008 Aug;28(7):1026-33 - PubMed
  9. Clin Gastroenterol Hepatol. 2013 Nov;11(11):1399-1412.e7 - PubMed
  10. Gastroenterology. 1996 Nov;111(5):1200-5 - PubMed
  11. Clin Immunol. 2008 Jan;126(1):67-80 - PubMed
  12. Gastroenterology. 2009 Nov;137(5):1776-84 - PubMed
  13. Am J Physiol Gastrointest Liver Physiol. 2014 Apr 15;306(8):G641-9 - PubMed
  14. Curr Gastroenterol Rep. 2009 Jun;11(3):190-4 - PubMed
  15. Mol Biol Cell. 2014 Sep 15;25(18):2710-9 - PubMed
  16. Clin Gastroenterol Hepatol. 2013 Apr;11(4):366-72 - PubMed
  17. J Gastrointest Oncol. 2012 Sep;3(3):226-31 - PubMed
  18. Gut. 2008 Oct;57(10):1366-74 - PubMed
  19. Dig Dis Sci. 2011 Dec;56(12):3492-7 - PubMed
  20. Am J Physiol Gastrointest Liver Physiol. 2007 Feb;292(2):G518-25 - PubMed
  21. Gut. 2007 Jun;56(6):749-55 - PubMed
  22. Vitam Horm. 2006;74:443-77 - PubMed
  23. Am J Gastroenterol. 2004 Jun;99(6):1037-43 - PubMed

Publication Types