title: Dilated intercellular spaces and lymphocytes on biopsy relate to symptoms in erosive GERD but not NERD.
abstract: BACKGROUND
  Mechanisms of symptom perception among patients with gastro-oesophageal reflux disease (GERD) remain to be fully elucidated.
  
  
  OBJECTIVE
  To correlate quantitative reflux symptom scores with microscopic oesophageal histopathology.
  
  
  METHODS
  Prior to endoscopy, patients with reflux symptoms completed a validated reflux disease questionnaire (score 0-36). Erosive oesophagitis (EO) was graded using the LA classification. Oesophageal biopsies were graded 0-2 for basal cell hyperplasia, papillary elongation, dilated intercellular spaces (DIS), necrosis or erosion, eosinophils and neutrophils by a blinded gastrointestinal pathologist as previously described. Additionally, lymphocyte density was also evaluated. Pearson's correlation coefficients were computed.
  
  
  RESULTS
  Thirty-two EO and 21 non-erosive reflux disease (NERD) patients were prospectively enrolled. For EO vs. NERD, mean reflux symptom scores (10.7 vs. 8.8, P=0.35) and histology scores were similar (4.29 vs. 4.25; P=0.9). However, when symptom scores were compared with histology scores, a correlation was found in the EO group, but not in the NERD group (r=0.34, P=0.05 vs. r=0.22, P=0.36). On further analysis, DIS was associated with symptom scores in the EO group (P≤0.001), but not in the NERD group (P=N.S.). Similarly, lymphocyte density was associated with symptom scores in the EO group (r=0.56, P=0.0009), but not in the NERD group (r=0.002, P=0.9).
  
  
  CONCLUSIONS
  Although mean symptom and histology scores were similar in the EO and NERD groups, a significant correlation of symptom scores with histology scores, DIS and lymphocytes was found in the former, but not in the latter. EO and NERD patients may have different symptom perception mechanisms and thus, dissimilar symptom resolution rates with acid suppression.
authors: Division of Gastroenterology and Hepatology, Department of Veterans Affairs Medical Center, 4801 E. Linwood Blvd, Kansas City, MO 64128-2295, USA.
authors: R A
authors: RA
authors: Tadiparthi
authors: A
authors: A
authors: Bansal
authors: S
authors: S
authors: Wani
authors: S
authors: S
authors: Mathur
authors: S B
authors: SB
authors: Hall
authors: A
authors: A
authors: Rastogi
authors: A
authors: A
authors: Higbee
authors: S
authors: S
authors: Gaddam
authors: P
authors: P
authors: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005110:Extracellular Space / Q000502:physiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000473:pathology*; D006356:Heartburn / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008214:Lymphocytes / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013223:Statistics as Topic; D011795:Surveys and Questionnaires