Microscopic esophagitis in gastro-esophageal reflux disease: individual lesions, biopsy sampling, and clinical correlations.
Patients with non-erosive reflux disease may show microscopic damage. This study is aimed to describe distribution, sensitivity, and specificity of histological lesions (i.e., basal cell hyperplasia-BH, papillae elongation-PE, dilatation of intercellular spaces-DIS, intraepithelial eosinophils-IE, neutrophils, and erosions) and sampling criteria. Four groups were identified on the basis of symptoms, endoscopy, and pH monitoring: (1) erosive esophagitis (n = 48), (2) non-erosive esophagitis with abnormal pH (n = 59), (3) non-erosive esophagitis with normal pH (n = 12), and (4) controls (n = 20). Biopsies were taken at the Z-line and 2 and 4 cm above it. BH, PE, DIS, IE, neutrophils, and erosions were assessed. A global severity score was calculated on the basis of the above parameters and allowed the distinction of patients from controls with 80% sensitivity and 85% specificity. Lesions were more severe at Z-line than proximally and more expressed in erosive than in non-erosive disease, although more than 70% of latter patients still showed histological damage. Esophageal biopsy seems very attractive in non-erosive disease where it may contribute to diagnosis and play a role in the comparative evaluation of different therapies.
Mastracci
Luca
L
Department of Anatomic Pathology, University of Genova, Genova, Italy.
Spaggiari
Paola
P
Grillo
Federica
F
Zentilin
Patrizia
P
Dulbecco
Pietro
P
Ceppa
Paola
P
Baccini
Paola
P
Mansi
Carlo
C
Savarino
Vincenzo
V
Fiocca
Roberto
R
D000328:Adult; D000368:Aged; D001706:Biopsy; D016022:Case-Control Studies; D004804:Eosinophils / Q000473:pathology; D004848:Epithelium / Q000473:pathology; D050782:Esophageal pH Monitoring; D004941:Esophagitis / Q000175:diagnosis / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index