The value of esophageal histology in the diagnosis of gastroesophageal reflux disease in patients with heartburn and normal endoscopy.

Histologic markers of reflux-induced mucosal injury are demonstrable in patients with nonerosive gastroesophageal reflux disease (neGERD). They include papillary elongation, basal cell hyperplasia, and dilation of intercellular spaces, especially of the prickle layer. These abnormalities are responsive to acid-suppressive therapy. Unfortunately, the longitudinal and circumferential distributions of these anomalies are nonuniform. They are presumably focalized on top of the esophageal folds, where the brunt of acid exposure and injury occurs. Therefore, based on current evidence, routine, random, nontargeted biopsies of the distal esophagus cannot be recommended in patients with neGERD. This may change if future studies reveal a high sensitivity and specificity of biopsies obtained from the squamocolumnar junction and the tops of the mucosal folds at 2 cm and 4 to 5 cm in patients with neGERD.