Red streaks in the oesophagus in patients with reflux disease: Is there a histomorphological correlate?

The Los Angeles classification of reflux oesophagitis includes sharply dema rcated areas of erythema without any associated slough within the definitio n of reflux-induced mucosal breaks, though there is uncertainty as to wheth er these "red streaks" actually represent such a mucosal lesion. This study evaluates the histopathology of these red streaks. Methods: Forty patients with one or more red streaks on the tops of the mucosal folds in the dista l oesophagus were included in a multinational, multicentre prospective stud y. All patients were referred for upper gastrointestinal endoscopy to inves tigate chronic heartburn and acid regurgitation. Biopsies were taken from t he red streaks and from control biopsies from more normal appearing mucosa I cm lateral to the red streaks. A two-sided probability test using normal approximation assessed differences in the histological findings at the two biopsy locations. Results: Compared to control biopsies, biopsies of red st reaks had a significantly thicker basal cell layer (mean +/- s 41% +/- 32% versus 18% +/- 23% of mucosal thickness, P=0.001) and longer papillae (mean +/- s 71% +/- 19% versus 49% +/- 24% of mucosal thickness, P = 0.001). Of the red streak biopsies, 25% had either newly re-epithelized lesions or gra nulation tissue beneath squamous epithelium. Only 10% of the control biopsi es had moderate or more marked regenerative changes (based on elongation of papillae and basal cell hyperplasia), compared to 65. 1 % of red streak bi opsies. Of the biopsies from the red streak itself, 7% showed no abnormalit y and 27.9% only slight changes. In comparison, 25% of the biopsies from co ntrol biopsies showed no regenerative changes and 62.5% only slight change due to gastrooesophageal reflux disease, Conclusion: The histomorphological counterpart to the endoscopically visible red streaks of the distal oesoph agus is marked regenerative changes of the squamous epithelium and/or capil lary rich granulation tissue beneath the squamous epithelium. Red streaks a re validated as being indicative of acid/peptic mucosal injury, but they do not satisfy a strict definition of a mucosal break.