Histopathological spectrum in patients of gastro-esophageal reflux disease: A prospective study in a Tertiary Care Institute

Abstract

Introduction: Gastroesophageal reflux disease (GERD) presents with classical symptoms of heart burn and acid regurgitation. Endoscopically, it is divided into erosive reflux disese (ERD) and non-erosive reflux disease (NERD) depending on the presence or absence of visible mucosal breaks in esophagus. Aims: This prospective study was undertaken with the aim to assess the histopathological spectrum in esophageal biopsies taken from patients with GERD. Method: Esophageal biopsies were taken from 150 patients of GERD and 50 controls. GERD cases were defined by the presence of classical symptoms of heart burn and/or acid regurgitation. Endoscopically, GERD cases were subdivided into ERD (n=70) and NERD (n=80). Six histological parameters studied in esophageal biopsy were basal cell hyperplasia, papillary elongation, dilatation of intercellular spaces, intra-epithelial eosinophil, intra-epithelial neutrophil and erosion/necrosis. Each parameter was given a score (range: 0-2) and total score of microscopic lesions ranged from 0-12 and a cut-off value (score ?2) was used to distinguish GERD patients from controls. Results: Histological alterations were observed in 144 (96%) of GERD patients. All controls had esophageal biopsy score of 2, while 74(92.5%) NERD and 70(100%) ERD patients had a score?2. Esophageal biopsy had a sensitivity of 96% and specificity of 92%. Conclusion: The high sensitivity and specificity of histopathology findings leads us to strongly support the role of esophageal biopsy in diagnosing GERD especially NERD.