Reassessment of the diagnostic value of histology in patients with GERD, using multiple biopsy sites and an appropriate control group.
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.
Zentilin
Patrizia
P
Dipartimento di Medicina Interna e Specialità Mediche, University of Genoa, Genoa, Italy.
Savarino
Vincenzo
V
Mastracci
Luca
L
Spaggiari
Paola
P
Dulbecco
Pietro
P
Ceppa
Paola
P
Savarino
Edoardo
E
Parodi
Andrea
A
Mansi
Carlo
C
Fiocca
Roberto
R
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