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It is only when this defence is overcome that reflux\u2010induced damage ensues.<\/jats:p><jats:p>The light microscopic changes in reflux oesophagitis are manifold. Early changes are confined to the epithelium and consist of reactive changes and inflammatory cell infiltration. When the epithelial integrity can no longer be maintained, erosions and ulcers develop.<\/jats:p><jats:p>Recently, dilatation of the intercellular spaces was described as a sensitive early marker for gastro\u2010oesophageal reflux disease. This parameter was first identified by electron microscopy but can also be assessed by light microscopy in routinely stained tissue sections.<\/jats:p><jats:p>Some of the changes occurring in early gastro\u2010oesophageal reflux disease can be reproduced by incubating oesophageal mucosal biopsies in gastrointestinal fluids or their components. Activated pepsin, trypsin and conjugated bile acids at an acidic pH have been identified as probable causes of reflux\u2010induced damage.<\/jats:p>","DOI":"10.1111\/j.1365-2036.2006.03037.x","type":"journal-article","created":{"date-parts":[[2010,7,23]],"date-time":"2010-07-23T11:42:09Z","timestamp":1279885329000},"page":"17-26","source":"Crossref","is-referenced-by-count":20,"title":["Review article: the nature of oesophageal injury in gastro\u2010oesophageal reflux disease"],"prefix":"10.1111","volume":"24","author":[{"given":"G.","family":"DE HERTOGH","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"ECTORS","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"VAN EYKEN","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"GEBOES","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2006,8,21]]},"reference":[{"key":"e_1_2_8_2_2","first-page":"325","article-title":"Twenty\u2010four\u2010hour pH monitoring of the distal esophagus. 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