What Parameters Are Relevant for the Histological Diagnosis of Gastroesophageal Reflux Disease without Barrett’s Mucosa?

Abstract

Background/Aims: There are still ongoing controversies as to which histological parameters allow the diagnosis of gastroesophageal reflux disease (GERD). The aim of the present analysis was to relate histological changes of the esophageal squamous epithelium to different severities of GERD. Methods: Data were obtained from patients participating in the ProGERD study, who had either erosive reflux disease (ERD, n = 3,245) or non-erosive reflux disease (NERD, n = 2,970). 1,475 patients fulfilled our requirement of having complete biopsy data from two sites (2 cm above the z-line and at the z-line). Changes in the squamous epithelium were assessed by measuring the thickness of the basal cell layer and elongation of the papillae as a percentage of the whole epithelial thickness and counting interepithelial inflammatory cells. Results: The most useful parameters for histological assessment of GERD (given as means, 2 cm above the z-line and at the z-line, respectively) were elongation of the papillae: NERD 40.7 and 48.9%; ERD 46.1 and 54.9% and basal cell hyperplasia: NERD 12.7 and 17.9%; ERD 15.7 and 23.0%. The occurrence of intraepithelial lymphocytic infiltrates, however, is dependent on the severity of GERD, and they are more common than neutrophilic and eosinophilic granulocytes. Conclusion: This study shows that both NERD and ERD can be diagnosed histologically if biopsies are obtained from the distal esophagus or from the z-line. Intraepithelial inflammatory cells are rare and show a high specificity, but very low sensitivity.

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

“…The intention of the current study was, therefore, not to test the clinical relevance of microscopic lesions, but to establish criteria for consistently measuring these features and determine their reproducibility across a spectrum of histologic abnormalities, so that their clinical relevance can be reliably determined in future studies. While previous attempts have been made to define histologic criteria for the recognition of microscopic lesions, most have been developed at single centers and have not been adequately validated [8][9][10][11].…”

Recent trends in GERD: problems of diagnosis and treatment

“…In one of our own previous analyses we were able to show that regenerative alterations in squamous epithelium relate well to the endoscopically assessed severity of GERD, assessed by the LA classification [22]. One parameter that has been discussed in more detail during the past 5 years is the finding of dilated intercellular spaces within the parabasal cell layer [23]. This finding was first described in electron microscopy and was adapted to light microscopy, even if it is obvious that these dilated intercellular spaces do not occur without other regenerative changes [23,24].…”

“…One parameter that has been discussed in more detail during the past 5 years is the finding of dilated intercellular spaces within the parabasal cell layer [23]. This finding was first described in electron microscopy and was adapted to light microscopy, even if it is obvious that these dilated intercellular spaces do not occur without other regenerative changes [23,24]. This speculation is based on several hypotheses: (1) acid and pepsin reduce the electrical resistance of the mucosa (even without visible lesions); (2) reduced electrical resistance is associated with increased permeability for larger molecules (including epidermal growth factor, which stimulates epithelial proliferation); (3) reduced electrical resistance normalizes after proton pump inhibitor (PPI) treatment; and (4) in electron microscopy, dilatation of intercellular spaces is the morphological correlate of reduced epithelial resistance.…”

Identification of Clinical and Laboratory Markers for Predicting Eosinophilic Esophagitis in Adults

“…The pattern of gastritis was evaluated by the updated Sydney System [17]. Gastroesophageal reflux-associated esophagitis was excluded using the Ismail-Beigi criteria [18] modified by Vieth et al [19]. According to Collins [20], EoE was diagnosed based on major features such as increased intraepithelial eosinophils (≥15 per high-power field of 0.55 mm 2 in areas of peak density), eosinophilic microabscesses, aggregates of eosinophils in the epithelial surface layers, degranulation of eosinophils, and surface sloughing of epithelial cells and eosinophils in ≥2 biopsies (levels).…”