DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161441

Histological correlates of gastro esophageal reflux disease in South Indian population

Jawahar Ramasamy, George Kurian, Renu G’Boy Varghese, Thomas Alexander

Abstract


Background: Diagnosing gastroeosopageal reflux disease (GERD) accurately is a complex problem. This study was conducted to examine the histological findings of GERD in Indian subjects. Esophageal biopsy can be combined with pH monitoring and endoscopy to define the histological damage that occurs due to acid regurgitation. The sensitivity and specificity of the individual findings needs clarity in this clouded area in order to be of use to the pathologist.

Methods: A total of 102 patients with dyspepsia were included in this study. Those with heartburn and /or regurgitation were identified as patients with GERD and those without these symptoms were treated as cases of non GERD dyspepsia. Biopsies were taken 2cm above 'Z' line in all cases. The biopsies were read by a single pathologist. Basal cell hyperplasia (BCH), neutrophilic exocytosis (NE), dilated intercellular spaces (DIS), papillary elongation (PE) and lymphoid aggregates (LA), necrosis (NEC) and eosinophilic infiltration were studied. 

Results: 68 patients had GERD dyspepsia and 34 had non GERD dyspepsia. The histological findings of BCH, NE, PE, DIS, LA were found to be found much more often in patients with GERD symptoms (p values ranged from 0.0001 to 0.0008). We found BCH and papillary elongation together were the most sensitive histological findings. Specificity was highest when DIS combined with NE.

Conclusions: In this study we found basal cell hyperplasia is the most common histological finding, and when combined with DIS or papillary elongation enhances its sensitivity. However to exclude other causes of dyspepsia, a combination of DIS, PE and NE can be used effectively.

 


Keywords


Dyspepsia, Dilated intercellular spaces, Basal cell hyperplasia, Endoscopy

Full Text:

PDF

References


Kahrilas PJ, Quigley EMM. American Gastrointestinal Association medical position statement: guidelines on the use of esophageal pH recording. Gastroenterology. 1996;110:1981-96.

Dent J, Vakil N, Jones R, Bytzer P, Schoning U, Halling K, et al. Accuracy of the diagnosis of GORD by questionnaire, physicians and a trial of proton pump inhibitor treatment: the Diamond Study. Gut. 2010;59(6):714-21.

Funch-Jensen P, Kock K, Christensen LA, Fallingborg, Kjærgaard J, Andersen SP, et al. Microscopic appearance of the esophageal mucosa in a consecutive series of patients submitted to endoscopy: Correlation with gastroesophageal reflux symptoms and microscopic findings. Scand J Gastroenterol. 1986;21:65-8.

Voutilainen M, Färkkilä M, Juhola M, Mecklin JP, Sipponen P. Gastroesophaeal reflux disease; prevalence, clinical, endoscopic and histopathological findings in1128 consecutive patients referred for endoscopy due to dyspeptic and reflux symptoms. Digestion. 2000;61:6-13.

Tadiparthi RA, Bansal A, Wani S, Mathur S, Hall SB, Rastogi A, et al. Dilated intercellular spaces and lymphocytes on biopsy relate to symptoms in erosive GERD but not NERD. Aliment Pharmacol Ther. 2011;33:1202-8.

Cui RL, Zhou LY, Lin SR, Xue Y. A study on the light microscopic measurement of intercellular space of squamous epithelium in lower-esophagus to diagnose gastroesophageal reflux disease. Zhonghua Nei Ke Za Zhi. 2009;48(3):208-12.

Cui R, Zhou L, Lin S, Xue Y, Duan L, Xia Z, et al. The feasibility of light microscopic measurements of intercellular spaces in squamous epithelium in the lower-oesophagus of GERD patients. Dis Esophagus. 2011;24(1):1-5.

Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis. Am J Surg Pathol. 1996;20(10):1161-81.

Ribolis M, Perrone G, Cavigilia R, Gentile M, Emerenziani S, Luca Guarino MP, et al. Intercellular space diameters of the oesophageal epithelium in NERD patients: head to head comparison between light and electron microscopy analysis. Dig Liver Dis. 2009;41(1):9-14.

Locke GR, Talley NJ, Weaver AI, ZZinsmeister AR. A new questionnaire for gastroesophageal reflux disease. Mayo Clin Proc. 1994;69:539-47.