Reassessment of the Diagnostic Value of Histology in Patients with GERD, Using Multiple Biopsy Sites and an Appropriate Control Group

TLDR

Histology is generally considered a tool of limited value in diagnosing gastro‑esophageal reflux disease. The study reevaluates the diagnostic value of histology in GERD by using multiple biopsy sites and a suitable control group. Patients underwent upper‑GI endoscopy with Los Angeles grading, biopsies at the Z‑line, 2 cm and 4 cm above it, microscopic esophagitis scoring, and 24‑hour pH monitoring, with 20 asymptomatic controls. Histology was abnormal in 84 % of GERD patients versus 15 % of controls, with 96 % of erosive and 76 % of NERD cases showing lesions, and a score ≥ 2 effectively discriminated GERD from controls, indicating histology is a useful diagnostic tool, especially for NERD.

Abstract

Histology is generally considered as a tool of limited value in the diagnosis of gastro-esophageal reflux disease (GERD).To reevaluate the diagnostic role of histological alterations in GERD, using multiple biopsy sites and an appropriate control group.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.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.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.