Endoscope versus microscope in the diagnosis of esophageal non-erosive reflux disease: a study of 71 cases
Arul, P.; Phansalkar, M.; Alexander, T.; Padhi, S.; Vinoth, B.
Malaysian Journal of Pathology 36(3): 181-188
2014
ISSN/ISBN: 0126-8635 PMID: 25500517 Document Number: 673424
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. 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. 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. 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.