title: Oesophageal histology in gastro-oesophageal reflux disease is of minor pre- and postoperative diagnostic value.
abstract: OBJECTIVE
  The clinical value of oesophageal histology in non-complicated gastro-oesophageal reflux disease (GORD) is controversial. Our aim was to explore the role of histology in preoperative diagnosis and postoperative follow-up in GORD.
  
  
  METHODS
  From 40 patients 2 histopathologists graded and scored 191 oesophageal biopsies in a blinded manner to evaluate inter- and intraobserver variation pre- and postoperatively. Correlation between preoperative histology and objective clinical findings (endoscopy, esophageal 24-hour pH monitoring, and manometry) was calculated as well.
  
  
  RESULTS
  Pathologist I interpreted 16 (50%) preoperative biopsies as normal, 5 (16%) with mild, 4 (12.5%) moderate, and 7 (21.9%) severe reflux changes. Pathologist II interpreted 11 (35.5%) preoperative biopsies as normal, 11 (35.5%) with mild, 6 (19.4%) moderate, and 3 (9.7%) severe reflux changes. In preoperative biopsies, interobserver variation was 33.8% and intraobserver variation 9.7%. A positive correlation was detectable between preoperative endoscopic and morphologic findings; no correlation existed between either acid reflux or LES pressure and oesophageal morphology. Normal pH monitoring and fundic wrap were noted postoperatively in all cases. In postoperative histology no significant differences according to pathologist I existed when compared with preoperative changes: 22 normal (69%), 7 mild (22%), 1 moderate (3.1%), and 2 severe (6.3%). Compared to preoperative analysis, pathologist II interpreted 24 (77%, p = 0.001) of the postoperative findings as normal, 1 (3%, p = 0.003) as mild, 4 (12.9%, n.s.) as moderate, and 2 (6.5% n.s.) as severe reflux changes. In postoperative biopsies interobserver variation was 21.1% and intraobserver variation 5.6%.
  
  
  CONCLUSIONS
  The role of oesophageal histology in preoperative diagnosis and postoperative follow-up of GORD may be considered limited.
authors.affiliation: Department of Surgery, Tampere University Hospital, Tampere, Finland.
authors.forename: Tuomo K
authors.initials: TK
authors.lastname: Rantanen
authors.forename: Judith E
authors.initials: JE
authors.lastname: Mäkinen
authors.forename: Pentti I
authors.initials: PI
authors.lastname: Sipponen
authors.forename: Eero I T
authors.initials: EI
authors.lastname: Sihvo
authors.forename: Ari
authors.initials: A
authors.lastname: Leppäniemi
authors.forename: Jarmo A
authors.initials: JA
authors.lastname: Salo
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index