Clinical utility of histology in non-erosive gastro-esophageal reflux disease.

Background: in the absence of gross oesophageal erosions longterm ph monitoring is the present gold standard for diagnosing gastro-esophageal reflux disease.this method, however, is invasive, time consuming and not generally available. Aim of the study: this study was specifically designed to determine the diagnostic value of histological findings in patients with non-erosive gastro-esophageal reflux disease. Study design: an observational, cross-sectional study. Patients and methods:68 patients (36 males & 32 females) complaining of typical gerd symptoms for at least 12 weeks, not necessarily consecutive, during the previous 12 months were enrolled in this study. They underwent upper gi endoscopy and los angeles classification was used for grading cases with mucosal breaks and biopsies were taken from esophago-gastric junction. 24 hour ph monitoring and esophageal manometry were also performed for each patient.correlation/regression analysis was done on clinical, endoscopic and histological findings. Fifteen apparently healthy subjects (9 males and 6 females) not complaining of any gerd symptoms were recruited as controls. Results:four groups were identified on the basis of symptoms, endoscopy, and ph monitoring: (1) erosive esophagitis (n=24), (2) non-erosive esophagitis with abnormal ph (n=33), (3) non-erosive esophagitis with normal ph (n=11), and (4) controls (n=15).the presence of erosive esophagitis was directly correlated to male gender (p=0.0225) , current smoking (p= 0.0227) and hiatus hernia (p=0.0086).biopsies were assessed for basal cell hyperplasia, papillae elongation, intercellular space dilatation, intraepithelial eosinophils infiltration, intraepithelial neutrophil infiltration and erosions. A global severity score was calculated on the basis of the above parameters and allowed the distinction of patients from controls with 82.4% sensitivity and 86.7% specificity.there global severity score was directly correlated to the frequency of reflux episodes. It was also directly related to the time elapsed below ph 4.0 and the composite ph score. 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 where it may contribute to diagnosis and play a role in the comparative evaluation of different therapies.