Microscopic esophagitis in gastro-esophageal reflux disease: individual lesions, biopsy sampling, and clinical correlations

Abstract

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.

Refinement and Reproducibility of Histologic Criteria for the Assessment of Microscopic Lesions in Patients with Gastroesophageal Reflux Disease: the Esohisto Project

“…5), and are scored using light microscopy based on the technique previously reported by Villanacci et al [23] and Mastracci et al [13]. Light microscopy has been shown to be equally as effective as electron microscopy for detecting DIS [24].…”

“…Upper limit of basal cell layer = level above which the cell nuclei are separated by a distance greater than the nuclear diameter erosions) and dividing by the number of lesion types assessed [13]. In contrast with the images used in the evaluation of the draft criteria [12], the slides used in the current study were digitized whole slides that did not have the field of assessment indicated.…”

“…The severity of infiltration with intraepithelial eosinophils and with intraepithelial neutrophils is scored in one high-power field (940) as 0 (0 cells), 1 (1-2 cells), or 2 ([2 cells). These score cut-offs are based on those previously reported by Mastracci et al [13].…”

“…These cut-offs are partly based on prior data on the separation of patients with reflux from healthy controls [16] and are modified slightly from those previously reported in the literature [13,17,22].…”

Immunohistochemical analysis of Ki-67, p53 and Bcl-2 expression related to histological features in gastroesophageal reflux disease

“…The criteria used for histological assessment of biopsy specimens were basal cell hyperplasia, papillae elongation, infiltration of neutrophils and eosinophils, dilatation of capillaries within papillae, and presence of dilated intercellular spaces (DIS) (7)(8)(9). The criteria were semiquantitatively scored as none, mild, medium, and severe on H&E-stained slides obtained from each biopsy site.…”