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Endoscope versus microscope in the diagnosis of esophageal non-erosive reflux disease: a study of 71 cases.
Malays J Pathol. 2014 Dec; 36(3):181-8.MJ

Abstract

BACKGROUND

Non-erosive reflux disease (NERD) is a type of gastroesophageal reflux disease (GERD) defined as symptomatic GERD without mucosal breaks on endoscopy. There is no gold standard for diagnosis of NERD till date. Biopsy from the distal esophagus in patients of GERD is said to reveal characteristic, although non-specific injury patterns such as squamous cell hyperplasia and intraepithelial inflammatory cell infiltration, collectively known as microscopic esophagitis. Recently, dilated intercellular spaces (DIS) are also shown to be associated with NERD. The present study was undertaken to evaluate the role of biopsy in NERD cases.

MATERIALS AND METHODS

Two mucosal biopsies were taken at 3 cm above the squamocolumnar junction (SCJ) from 71 cases of NERD having symptom scores of more than 10. Biopsies were evaluated for features of microscopic esophagitis and DIS, and the results were analyzed.

RESULTS

Fifty out of 71 (70.4%) patients with symptomatic NERD had features of microscopic esophagitis. DIS was noted in 46/71 (64.8%) of cases, and correlated significantly with microscopic esophagitis (p<0.0001). Basal cell hyperplasia, papillary elongation, intraepithelial neutrophils, and intraepithelial eosinophils were seen in 83.1%, 76.1%, 40.8%, and 12.7% of NERD cases respectively.

CONCLUSION

In symptomatic patients of GERD, when endoscopy does not show mucosal breaks (so called NERD), histopathological evaluation of distal esophageal mucosa may have a diagnostic value. The present study also reinforces the diagnostic utility of DIS in symptomatic NERD.

Authors+Show Affiliations

Pondicherry Institute of Medical Sciences, Departments of Pathology, India. drarul3@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

25500517

Citation

Arul, P, et al. "Endoscope Versus Microscope in the Diagnosis of Esophageal Non-erosive Reflux Disease: a Study of 71 Cases." The Malaysian Journal of Pathology, vol. 36, no. 3, 2014, pp. 181-8.
Arul P, Phansalkar M, Alexander T, et al. Endoscope versus microscope in the diagnosis of esophageal non-erosive reflux disease: a study of 71 cases. Malays J Pathol. 2014;36(3):181-8.
Arul, P., Phansalkar, M., Alexander, T., Padhi, S., & Vinoth, B. (2014). Endoscope versus microscope in the diagnosis of esophageal non-erosive reflux disease: a study of 71 cases. The Malaysian Journal of Pathology, 36(3), 181-8.
Arul P, et al. Endoscope Versus Microscope in the Diagnosis of Esophageal Non-erosive Reflux Disease: a Study of 71 Cases. Malays J Pathol. 2014;36(3):181-8. PubMed PMID: 25500517.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscope versus microscope in the diagnosis of esophageal non-erosive reflux disease: a study of 71 cases. AU - Arul,P, AU - Phansalkar,M, AU - Alexander,T, AU - Padhi,S, AU - Vinoth,B, PY - 2014/12/16/entrez PY - 2014/12/17/pubmed PY - 2015/3/11/medline SP - 181 EP - 8 JF - The Malaysian journal of pathology JO - Malays J Pathol VL - 36 IS - 3 N2 - BACKGROUND: Non-erosive reflux disease (NERD) is a type of gastroesophageal reflux disease (GERD) defined as symptomatic GERD without mucosal breaks on endoscopy. There is no gold standard for diagnosis of NERD till date. Biopsy from the distal esophagus in patients of GERD is said to reveal characteristic, although non-specific injury patterns such as squamous cell hyperplasia and intraepithelial inflammatory cell infiltration, collectively known as microscopic esophagitis. Recently, dilated intercellular spaces (DIS) are also shown to be associated with NERD. The present study was undertaken to evaluate the role of biopsy in NERD cases. MATERIALS AND METHODS: Two mucosal biopsies were taken at 3 cm above the squamocolumnar junction (SCJ) from 71 cases of NERD having symptom scores of more than 10. Biopsies were evaluated for features of microscopic esophagitis and DIS, and the results were analyzed. RESULTS: Fifty out of 71 (70.4%) patients with symptomatic NERD had features of microscopic esophagitis. DIS was noted in 46/71 (64.8%) of cases, and correlated significantly with microscopic esophagitis (p<0.0001). Basal cell hyperplasia, papillary elongation, intraepithelial neutrophils, and intraepithelial eosinophils were seen in 83.1%, 76.1%, 40.8%, and 12.7% of NERD cases respectively. CONCLUSION: In symptomatic patients of GERD, when endoscopy does not show mucosal breaks (so called NERD), histopathological evaluation of distal esophageal mucosa may have a diagnostic value. The present study also reinforces the diagnostic utility of DIS in symptomatic NERD. SN - 0126-8635 UR - https://www.unboundmedicine.com/medline/citation/25500517/Endoscope_versus_microscope_in_the_diagnosis_of_esophageal_non_erosive_reflux_disease:_a_study_of_71_cases_ L2 - http://www.mjpath.org.my/2014/v36n3/esophageal-non-erosive-reflux-disease.pdf DB - PRIME DP - Unbound Medicine ER -