Esophageal histology does not provide additional useful information over clinical assessment in identifying reflux patients presenting for esophagogastroduodenoscopy

We prospectively evaluated the value of histology in identifying gastroesop hageal reflux disease (GERD) in consecutive patients enrolled for upper end oscopy. GERD was defined as heartburn occurring at least weekly. Macroscopi c esophagitis was graded and an esophageal biopsy was taken 2 cm above the gastroesophageal junction. Histological esophagitis was identified by: (1) basal cell hyperplasia >15%, (2) increased papillary length >66%, and (3) i nfiltration by leukocytes/eosinophils. The sensitivity, specificity, and po sitive and negative predictive value of histological esophagitis in patient s with and without typical reflux symptoms, with and without endoscopic cha nges, or both were evaluated. Of 178 patients, reflux symptoms were present in 59% (N = 105) and esophageal erosions in 19% (N = 34); 75 patients had reflux symptoms but no erosions. While the specificity of histology was ade quate (78%), it was insensitive (30%). The positive and negative predictive values were 67% and 44%, respectively. No single individual parameter was better than any other. Thus, histology appears to be of no additional value in identifying GERD.