Diagnosing gastroesophageal reflux disease: the pathologist's perspective.
ABSTRACT 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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ABSTRACT: The initial response of esophageal mucosa to gastroduodenal reflux is inflammation and hyperplasia. Secretory phospholipase A(2) (sPLA(2)) is a known mediator of gut inflammation, and its levels are increased in Barrett's esophagus. We hypothesized that the sPLA(2) gene is required to produce esophageal mucosal hyperplasia in response to gastroduodenal reflux. C57BL/6 (n = 5) sPLA(2) (-/-) mice and C57BL/6( Cg-Tg(PLA2G2A)703N16 ) mice (n = 4) sPLA(2) (-/+) underwent a side-to-side surgical anastomosis between the duodenum and gastroesophageal junction (DGEA). Control animals [sPLA(2) (-/-) (n = 5), sPLA(2) (-/+) (n = 4)] underwent laparotomy with incision and repair of the esophagus. Tissue was harvested after 4 weeks, and H&E staining was performed to quantify esophageal mucosal thickness. Ki67 and sPLA(2) immunostaining were performed to quantitate differences in cell division and sPLA(2) expression. Mice expressing human sPLA(2) had a 2.5-fold increase in thickness of the esophageal mucosa as compared to controls (p = 0.01). A 6.5-fold increase in proliferation (p = 0.02) and a twofold increase in sPLA(2) expression (p = 0.04) were demonstrated in animals exposed to gastroduodenal reflux. The presence of sPLA(2) is necessary for early mucosal hyperplasia produced by exposure of the esophagus to gastroduodenal contents. sPLA(2) expression is upregulated by gastroduodenal reflux, strengthening its role as a critical mediator of early mucosal hyperplasia.Journal of Gastrointestinal Surgery 09/2009; 13(12):2212-8. DOI:10.1007/s11605-009-0972-x
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ABSTRACT: Esophagitis is essentially inflammation of the esophageal squamous mucosa. One of the major reasons for cause of Esophagitis is the acid reflux from the stomach. This condition is observed in the process of upper gastro-intestinal tract endoscopy and the diagnosis is arrived at by examining the images of the esophagus. The diagnosis is based on the observation of the lesions and coloration of the digestive mucosa. Our paper reports an implementation of Decision Support System (DSS) for diagnosis of Esophagitis based on the analysis of color and texture features of the images captured during the process of endoscopy. The Hue Saturation and Intensity color model is adapted. The statistical features of the Hue and Saturation form the color features and the texture features are determined by Discrete Cosine Transform coefficients of the image. The decision making structure is a feed forward neural network. The DSS has been tested and results are reported.Journal of Mechanics in Medicine and Biology 12/2009; 09(04). DOI:10.1142/S0219519409003097
Article: Esophageal Eosinophilia[Show abstract] [Hide abstract]
ABSTRACT: The presence of esophageal eosinophilia encompasses a broad differential diagnosis, and at times a specific histologic diagnosis is not possible. This content provides a systematic approach to esophageal squamous eosinophilia with emphasis on specific, distinguishing features within this expansive differential.Surgical Pathology Clinics 06/2010; 3(2):277-295. DOI:10.1016/j.path.2010.05.006