title: Reassessment of the diagnostic value of histology in patients with GERD, using multiple biopsy sites and an appropriate control group.
abstract: BACKGROUND
  Histology is generally considered as a tool of limited value in the diagnosis of gastro-esophageal reflux disease (GERD).
  
  
  OBJECTIVE
  To reevaluate the diagnostic role of histological alterations in GERD, using multiple biopsy sites and an appropriate control group.
  
  
  METHODS
  We studied 135 patients with typical and atypical symptoms of GERD. They underwent upper GI endoscopy and Los Angeles classification was used for grading cases with mucosal breaks. Biopsies were taken at the Z-line, 2 and 4 cm above it. Microscopic esophagitis was identified by necrosis/erosion, neutrophil/eosinophil intraepithelial infiltration, basal cell hyperplasia, elongation of papillae, dilation of intercellular spaces and a score (range: 0-2) was given for each lesion. Twenty-four-hour esophageal pH monitoring was performed in each patient. Twenty subjects without reflux symptoms, and with normal endoscopy and pH testing were considered as controls.
  
  
  RESULTS
  Histological alterations were found in 100 of 119 GERD patients (84%) and in 3 of 20 controls (15%) with a significant difference (p < 0.00001). Histology was abnormal in 96% of patients with erosive esophagitis and in 76% of patients with nonerosive reflux disease (NERD). The sum of scores of microscopic lesions found in all biopsy sites ranged from 0 to 22 and we identified a cut-off value (score 2) that distinguished efficiently controls from GERD patients.
  
  
  CONCLUSIONS
  In contrast with previous reports on the marginal role of histology in patients with GERD, our study shows that this technique can be a useful diagnostic tool, particularly in patients with NERD, when biopsies are taken at two sites including Z-line and 2 cm above it.
authors.affiliation: Dipartimento di Medicina Interna e Specialità Mediche, University of Genoa, Genoa, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Zentilin
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
authors.forename: Luca
authors.initials: L
authors.lastname: Mastracci
authors.forename: Paola
authors.initials: P
authors.lastname: Spaggiari
authors.forename: Pietro
authors.initials: P
authors.lastname: Dulbecco
authors.forename: Paola
authors.initials: P
authors.lastname: Ceppa
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
authors.forename: Andrea
authors.initials: A
authors.lastname: Parodi
authors.forename: Carlo
authors.initials: C
authors.lastname: Mansi
authors.forename: Roberto
authors.initials: R
authors.lastname: Fiocca
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D003430:Cross-Sectional Studies; D016099:Endoscopy, Gastrointestinal; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results