title: Clinical significance of esophageal histologic findings after antireflux surgery.
abstract: OBJECTIVE
  Only limited and controversial information exists regarding the histologic effect of successful antireflux surgery on esophageal mucosa and its clinical significance.
  
  
  METHODS
  A randomized, blinded follow-up study conducted in a university hospital between January 1, 1992, and December 31, 1997, with a mean follow-up of 8 months.
  
  
  METHODS
  Forty patients with severe symptomatic gastroesophageal reflux disease (24 men and 16 women; mean age, 50 years).
  
  
  METHODS
  Microscopic signs and severity of esophagitis analyzed by 2 blinded histopathologists.
  
  
  RESULTS
  Histopathologist 1 interpreted 22 (69%) of 32 postoperative biopsy specimens as normal; 7 (22%), as showing mild changes; 1 (3%), moderate changes; and 2 (6%), severe changes of reflux esophagitis. Histopathologist 2 interpreted 25 (78%) of 32 postoperative biopsy specimens as normal (P =.001); 1 (3%), as showing mild changes (P =.003); 4 (13%), moderate changes; and 2 (6%), severe changes. Between histopathologist 1 (90.6%) and histopathologist 2 (81%), the absence of esophageal mucosal inflammation correlated best with normalized pH monitoring.
  
  
  CONCLUSIONS
  These findings suggest that, if other findings such as those from fundic wrap at endoscopy and 24-hour pH monitoring are normal, the clinical significance of routine esophageal histologic examination after successful fundoplication is limited.
authors.affiliation: Department of Cardiothoracic Surgery, Helsinki University Central Hospital, PO Box 340, Haartmaninkatu 4, FIN-00029 Helsinki, Finland.
authors.forename: T K
authors.initials: TK
authors.lastname: Rantanen
authors.forename: J T
authors.initials: JT
authors.lastname: Salminen
authors.forename: J E
authors.initials: JE
authors.lastname: Mäkinen
authors.forename: P I
authors.initials: PI
authors.lastname: Sipponen
authors.forename: T A
authors.initials: TA
authors.lastname: Kiviluoto
authors.forename: J A
authors.initials: JA
authors.lastname: Salo
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D004942:Esophagitis, Peptic / Q000473:pathology* / Q000503:physiopathology; D004947:Esophagus / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome