Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Schneider, N.
Evolving Patterns in the Histologic Diagnosis of Reflux Esophagitis
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2014. pp. 70
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Langner Cord
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- Abstract:
- Objectives: Gastroesophageal reflux disease is a common disease with a rising prevalence in the world. In patients with gastroesophageal reflux disease histology is generally believed to be a tool of limited diagnostic value. Our study aimed to assess the prevalence and evaluate the clinical significance of microscopic esophageal lesions as defined by the Esohisto consensus guidelines which have proven high interobserver agreement in previous studies. Methods: In the prospective Central European multicenter histoGERD trial we recruited 1,071 individuals (576 female, 495 males; median age 53 years, range 15-93) undergoing gastroscopy for non-selected reasons. Biopsy material was systematically sampled from above and below the gastroesophageal junction. To validate the clinical importance of the histologic Esohisto criteria, we related their presence to clinical data including endoscopic findings as well as patients´ symptoms and therapy of gastroesophageal reflux disease. Results: Overall, histologic diagnosis of mild and severe esophagitis was made in 423 (39.5%) and 296 (27.6%) individuals, respectively, while the squamous mucosa of 352 (32.9%) individuals was normal upon histology or showed only insignificant findings. Proliferative changes of the squamous epithelium, in particular basal cell layer hyperplasia, papillary elongation, and intercellular space dilation were more common than inflammatory cell infiltration. The presence of microscopic esophagitis was associated with male gender (p=0.009), patients’ symptoms (p=0.003), history of proton pump inhibitor intake (p<0.001), and the endoscopic diagnosis of esophagitis (p<0.001). Notably, among the 450 patients with no endoscopic signs of esophagitis (Los Angeles Category N), 41.8% were identified with mild, and 17.1% with severe (microscopic) esophagitis, respectively, indicating higher sensitivity of histologic diagnosis. Conclusions: Our data illustrate the value of histology in the work-up of patients with reflux disease: We suggest that biopsies should routinely be obtained when patients undergo upper gastrointestinal endoscopy for evaluation of gastroesophageal reflux disease and may particularly be beneficial in patients with non-erosive reflux disease.