DIAGNOSTIC-VALUE OF HISTOLOGY IN NONEROSIVE GASTROESOPHAGEAL REFLUX DISEASE

Background-In the absence of oesophageal erosions longterm pH monitori ng is the present gold standard for diagnosing gastro-oesophageal refl ux disease (GORD). This method, however, is invasive, time consuming, expensive, and not generally available. Aims-As histological changes h ave been described in GORD, this study looked at the possibility of wh ether the diagnosis of non-erosive reflux disease could be made by his tological examination routinely during endoscopy. Subjects-A total of 24 prospectively selected patients with symptoms suggestive of GORD an d seven healthy volunteers. Methods-Oesophageal erosions and other pep tic lesions were excluded by oesophagogastroduodenoscopy. Oesophageal pinch biopsy specimens were taken 2 cm and 5 cm above the oesophagogas tric junction and evaluated blindly for the histological parameters ce llular infiltration, basal zone hyperplasia, and papillary length. Twe nty four hour pH monitoring was used as gold standard for the definiti on of reflux disease. It was abnormal in 13 patients (reflux patients) and normal in 11 patients (symptomatic controls) and in seven healthy volunteers. Results-Sparse infiltration of the epithelium with lympho cytes in at least one biopsy specimen was found in all patients and vo lunteers, with neutrophils in three reflux patients, and with eosinoph ils in two reflux patients and in two healthy volunteers. The basal zo ne thickness was increased in three reflux patients, in one symptomati c control, and in one healthy volunteer. The papillary length was grea ter than two thirds of total epithelium in six of 13 reflux patients i n contrast with none in 11 symptomatic controls (p<0.05) and to one he althy volunteer. The sensitivity of the parameter papillary length hen ce was only 46%. Conclusions-Although gastro-oesophageal reflux produc es slight histological changes apart from oesophageal erosions in a fe w subjects, none of the established histological parameters can fulfil the standards of a diagnostic tool. Routine pinch biopsies can not be recommended for the diagnosis of GORD in patients without visible oes ophageal erosions.