Diagnosing Gastroesophageal Reflux Disease

Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH 44195, USA.
Advances in anatomic pathology (Impact Factor: 3.23). 06/2009; 16(3):161-5. DOI: 10.1097/PAP.0b013e3181a186a3
Source: PubMed


Gastroesophageal reflux disease (GERD) is a common disease frequently encountered by surgical pathologists. Although the pathogenesis and clinical features of the disease have been studied for years, many unanswered questions remain. Typical clinical symptoms along with the endoscopic findings, pH monitoring, and biopsies, all support the diagnosis. However, these tests may yield conflicting findings, and at present there is no gold standard for the diagnosis of GERD. In patients with normal or nearly normal endoscopic findings (nonerosive reflux disease), the major diagnostic burden lies with the histology. The histologic diagnosis of GERD is based on a combination of findings, including basal cell hyperplasia, papilla elongation, inflammation, and dilatation of intercellular spaces. However, these features exhibit varying sensitivity and specificity, and minimal biopsy criteria for the diagnosis of reflux esophagitis have not been rigorously tested in well-characterized patient populations. However, given the high prevalence of GERD, pathologists face esophageal mucosal biopsies daily and must recognize the diagnostic strengths and limitations of histologic features of reflux esophagitis. Future studies and new techniques may improve the diagnostic strength of histology and establish meaningful minimal criteria for the diagnosis of reflux esophagitis.

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    • "Although all patients were given trials of PPIs, minimal improvement was seen with these medications. The proximal nature of our findings also leads us away from a diagnosis of reflux esophagitis, as many of the typical histology findings for GERD are often found near the squamocolumnar junction.12 "
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