Original Contribution
The American Journal of Gastroenterology (2005) 100, 2299–2306; doi:10.1111/j.1572-0241.2005.50209.x
Reassessment of the Diagnostic Value of Histology in Patients with GERD, Using Multiple Biopsy Sites and an Appropriate Control Group
Patrizia Zentilin MD1, Vincenzo Savarino MD1, Luca Mastracci MD2, Paola Spaggiari MD2, Pietro Dulbecco MD1, Paola Ceppa MD2, Edoardo Savarino MD1, Andrea Parodi MD1, Carlo Mansi MD1 and Roberto Fiocca MD2
- 1Dipartimento di Medicina Interna e Specialità Mediche, Morfologiche e Metodologie Integrate, University of Genoa, Genoa, Italy;
- 2Dipartimento di Discipline Chirurgiche, Morfologiche e Metodologie Integrate, University of Genoa, Genoa, Italy
Correspondence: Vincenzo Savarino, Cattedra di Gastroenterologia, Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, Viale Benedetto XV, N. 6, 16132 Genova, Italy
Received 8 February 2005; Revised 0000; Accepted 29 April 2005.
Abstract
BACKGROUND:
Histology is generally considered as a tool of limited value in the diagnosis of gastro-esophageal reflux disease (GERD).
AIM:
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.
