title: Validation study of the Esohisto consensus guidelines for the recognition of microscopic esophagitis (histoGERD Trial).
abstract: In patients with gastroesophageal reflux disease (GERD), histology is generally believed to be a tool of limited diagnostic value. Our study aimed to assess the prevalence of microscopic esophageal lesions as defined by the Esohisto consensus guidelines, which have proven high interobserver agreement in previous studies. In the prospective Central European multicenter histoGERD trial, we recruited 1071 individuals (576 females and 495 males; median age, 53 years; range, 15-93 years) undergoing gastroscopy for nonselected reasons. Biopsy material was systematically sampled from above and below the gastroesophageal junction. Overall, histologic diagnosis of mild and severe esophagitis was made in 423 (39.5%) and 296 (27.6%) individuals, respectively, whereas the squamous mucosa of 352 individuals (32.9%) was normal upon histology or showed only insignificant findings. Proliferative changes of the squamous epithelium, in particular basal cell layer hyperplasia, papillary elongation, and intercellular space dilation, were more common than inflammatory cell infiltration. The presence of microscopic esophagitis was associated with male sex (P = .009), patients' symptoms (P = .003), history of proton pump inhibitor intake (P < .001), and the endoscopic diagnosis of esophagitis (P < .001). Notably, among the 450 patients with no endoscopic signs of esophagitis (Los Angeles Category N), 41.8% and 17.1% were identified with mild and severe (microscopic) esophagitis, respectively, indicating higher sensitivity of histologic diagnosis. In conclusion, our data illustrate the value of histology in the workup of patients with reflux disease. We suggest that biopsies should routinely be obtained when patients undergo upper gastrointestinal endoscopy for evaluation of GERD and may particularly be beneficial in patients with nonerosive reflux disease.
authors.affiliation: Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria.
authors.forename: Nora I
authors.initials: NI
authors.lastname: Schneider
authors.affiliation: Department of Internal Medicine, Krankenhaus der Barmherzigen Brüder, Academic Teaching Hospital, 9300 St Veit/Glan, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Plieschnegger
authors.affiliation: Private Practice, 95444 Bayreuth, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Geppert
authors.affiliation: Private Practice, 49074 Osnabrück, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Wigginghaus
authors.affiliation: Department of Surgery, Division of General Surgery, Medical University of Graz, 8036 Graz, Austria.
authors.forename: Gabriele M
authors.initials: GM
authors.lastname: Hoess
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, 8036 Graz, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Eherer
authors.affiliation: Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria.
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Wolf
authors.affiliation: Department of Surgery, Research Unit for Biomedical Engineering & Computing, Medical University of Graz, 8036 Graz, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Rehak
authors.affiliation: Institute of Pathology, Klinikum Bayreuth, 95445 Bayreuth, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.affiliation: Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria. Electronic address: cord.langner@medunigraz.at.
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D004848:Epithelium / Q000473:pathology; D004941:Esophagitis / Q000175:diagnosis / Q000473:pathology*; D004943:Esophagogastric Junction / Q000473:pathology*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D013270:Stomach / Q000473:pathology
chemical_list: D054328:Proton Pump Inhibitors
keywords: Esophagitis; Gastroesophageal junction; Gastroesophageal reflux disease; Histology; Los Angeles classification; Pathology; Reflux