BACKGROUND: Microscopic esophagitis (ME) is common in patients with non-erosive reflux disease (NERD), and dilation of intercellular spaces (DIS) has been regarded as the potential main mechanism of symptom generation. We aimed to compare these histological abnormalities in healthy volunteers (HVs) and patients with erosive esophagitis (EE), NERD, and functional heartburn (FH). METHODS: Consecutive patients with heartburn prospectively underwent upper endoscopy and impedance-pH off-therapy. Twenty EE patients and fifty-seven endoscopy-negative patients (NERD), subclassified as 22 with pH-POS (positive for abnormal acid exposure), 20 with hypersensitive esophagus (HE; normal acid/symptom association probability [SAP]+ or symptom index [SI]+), and 15 with FH (normal acid/SAP-/SI-/ proton pump inhibitor [PPI] test-), were enrolled. Twenty HVs were also included. In each patient/control, multiple specimens (n = 5) were taken from the distal esophagus and histological alterations were evaluated. ME was diagnosed when the global histological score was >0.35. RESULTS: The prevalence of ME was higher (p < 0.0001) in EE (95 %), pH-POS (77 %), and HE (65 %) NERD patients than in FH patients (13 %) and HVs (15 %). Also, basal cell hyperplasia (p < 0.0023), DIS (p < 0.0001), and papillae elongation (p < 0.0002) showed similar rates of prevalence in the above populations (p < 0.0001). ME, including each histological lesion, had similar low frequencies in FH and HVs (p = 0.9990). Considering the histological abnormalities together, they permitted us to clearly differentiate EE and NERD from FH and HVs (p < 0.0001 and p < 0.0001, respectively). CONCLUSIONS: The lack of ME in the esophageal distal biopsies of FH patients indicates a limited role of these histological abnormalities in symptom generation in them. ME can be considered as an accurate and reliable diagnostic marker for distinguishing FH patients from GERD patients and has the potential to be used to guide the correct therapy.
BACKGROUND: Microscopic esophagitis (ME) is common in patients with non-erosive reflux disease (NERD), and dilation of intercellular spaces (DIS) has been regarded as the potential main mechanism of symptom generation. We aimed to compare these histological abnormalities in healthy volunteers (HVs) and patients with erosive esophagitis (EE), NERD, and functional heartburn (FH). METHODS: Consecutive patients with heartburn prospectively underwent upper endoscopy and impedance-pH off-therapy. Twenty EE patients and fifty-seven endoscopy-negative patients (NERD), subclassified as 22 with pH-POS (positive for abnormal acid exposure), 20 with hypersensitive esophagus (HE; normal acid/symptom association probability [SAP]+ or symptom index [SI]+), and 15 with FH (normal acid/SAP-/SI-/ proton pump inhibitor [PPI] test-), were enrolled. Twenty HVs were also included. In each patient/control, multiple specimens (n = 5) were taken from the distal esophagus and histological alterations were evaluated. ME was diagnosed when the global histological score was >0.35. RESULTS: The prevalence of ME was higher (p < 0.0001) in EE (95 %), pH-POS (77 %), and HE (65 %) NERD patients than in FHpatients (13 %) and HVs (15 %). Also, basal cell hyperplasia (p < 0.0023), DIS (p < 0.0001), and papillae elongation (p < 0.0002) showed similar rates of prevalence in the above populations (p < 0.0001). ME, including each histological lesion, had similar low frequencies in FH and HVs (p = 0.9990). Considering the histological abnormalities together, they permitted us to clearly differentiate EE and NERD from FH and HVs (p < 0.0001 and p < 0.0001, respectively). CONCLUSIONS: The lack of ME in the esophageal distal biopsies of FHpatients indicates a limited role of these histological abnormalities in symptom generation in them. ME can be considered as an accurate and reliable diagnostic marker for distinguishing FHpatients from GERDpatients and has the potential to be used to guide the correct therapy.
Authors: Edoardo Savarino; Radu Tutuian; Patrizia Zentilin; Pietro Dulbecco; Daniel Pohl; Elisa Marabotto; Andrea Parodi; Giorgio Sammito; Lorenzo Gemignani; Giorgia Bodini; Vincenzo Savarino Journal: Am J Gastroenterol Date: 2009-12-08 Impact factor: 10.864
Authors: Nikos Viazis; Anastasia Keyoglou; Alexandros K Kanellopoulos; George Karamanolis; John Vlachogiannakos; Konstantinos Triantafyllou; Spiros D Ladas; Dimitrios G Karamanolis Journal: Am J Gastroenterol Date: 2011-05-31 Impact factor: 10.864
Authors: Jean Paul Galmiche; Ray E Clouse; András Bálint; Ian J Cook; Peter J Kahrilas; William G Paterson; Andre J P M Smout Journal: Gastroenterology Date: 2006-04 Impact factor: 22.682
Authors: Carlo Calabrese; Mauro Bortolotti; Anna Fabbri; Alessandra Areni; Giovanna Cenacchi; Carlo Scialpi; Mario Miglioli; Giulio Di Febo Journal: Am J Gastroenterol Date: 2005-03 Impact factor: 10.864
Authors: R Carlsson; J Dent; E Bolling-Sternevald; F Johnsson; O Junghard; K Lauritsen; S Riley; L Lundell Journal: Scand J Gastroenterol Date: 1998-10 Impact factor: 2.423