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Reassessment of the diagnostic value of histology in patients with GERD, using multiple biopsy sites and an appropriate control group.
Am J Gastroenterol. 2005 Oct; 100(10):2299-306.AJ

Abstract

BACKGROUND

Histology is generally considered as a tool of limited value in the diagnosis of gastro-esophageal reflux disease (GERD).

AIM

To reevaluate the diagnostic role of histological alterations in GERD, using multiple biopsy sites and an appropriate control group.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Authors+Show Affiliations

Dipartimento di Medicina Interna e Specialità Mediche, University of Genoa, Genoa, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

16181384

Citation

Zentilin, Patrizia, et al. "Reassessment of the Diagnostic Value of Histology in Patients With GERD, Using Multiple Biopsy Sites and an Appropriate Control Group." The American Journal of Gastroenterology, vol. 100, no. 10, 2005, pp. 2299-306.
Zentilin P, Savarino V, Mastracci L, et al. Reassessment of the diagnostic value of histology in patients with GERD, using multiple biopsy sites and an appropriate control group. Am J Gastroenterol. 2005;100(10):2299-306.
Zentilin, P., Savarino, V., Mastracci, L., Spaggiari, P., Dulbecco, P., Ceppa, P., Savarino, E., Parodi, A., Mansi, C., & Fiocca, R. (2005). Reassessment of the diagnostic value of histology in patients with GERD, using multiple biopsy sites and an appropriate control group. The American Journal of Gastroenterology, 100(10), 2299-306.
Zentilin P, et al. Reassessment of the Diagnostic Value of Histology in Patients With GERD, Using Multiple Biopsy Sites and an Appropriate Control Group. Am J Gastroenterol. 2005;100(10):2299-306. PubMed PMID: 16181384.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reassessment of the diagnostic value of histology in patients with GERD, using multiple biopsy sites and an appropriate control group. AU - Zentilin,Patrizia, AU - Savarino,Vincenzo, AU - Mastracci,Luca, AU - Spaggiari,Paola, AU - Dulbecco,Pietro, AU - Ceppa,Paola, AU - Savarino,Edoardo, AU - Parodi,Andrea, AU - Mansi,Carlo, AU - Fiocca,Roberto, PY - 2005/9/27/pubmed PY - 2005/11/11/medline PY - 2005/9/27/entrez SP - 2299 EP - 306 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 100 IS - 10 N2 - BACKGROUND: Histology is generally considered as a tool of limited value in the diagnosis of gastro-esophageal reflux disease (GERD). AIM: To reevaluate the diagnostic role of histological alterations in GERD, using multiple biopsy sites and an appropriate control group. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/16181384/Reassessment_of_the_diagnostic_value_of_histology_in_patients_with_GERD_using_multiple_biopsy_sites_and_an_appropriate_control_group_ L2 - http://Insights.ovid.com/pubmed?pmid=16181384 DB - PRIME DP - Unbound Medicine ER -