Skip to main content
Log in

Histologic evaluation of chronic gastroesophageal reflux

An evaluation of biopsy methods and diagnostic criteria

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Controversy exists regarding the appropriate method for biopsy confirmation of esophageal reflux injury. We have compared endoscopic pinch biopsy (PB) with endoscopicallly directed Rubin tube suction biopsy (SB) in 40 patients with symptomatic gastroesophageal reflux disease (GERD). Utilizing a plastic tube attached alongside the endoscope, SB at specific sites in the esophagus can be easily obtained. Suction biopsy was rated superior to PB for adequacy of tissue, ability to make an interpretation, and certainty in diagnosis. These differences were most pronounced in patients with endoscopic grades 0 and 1+ esophagitis in which 59% of PBs were uninterpretable compared to 23% of SBs. The passage of the Rubin tube was easily done and could be performed repeatedly. Six of 40 patients (15%) developed substernal chest discomfort in the 24 hr following SB. We conclude that SB is the most appropriate way to evaluate histologic changes related to reflux injury and that this method is mandatory in symptomatic patients with minimal endoscopic evidence of esophagitis (0−1+).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Winans CS: The role of endoscopy in the diagnosis of esophageal pain, Proceedings from a seminar on chest pain. Drug Therapy. New York, Biomedical Information Corporation, 1980, pp 27–29

    Google Scholar 

  2. Ismail-Beigi F, Horton P, Pope C: Histologic consequences of gastroesophageal reflux in man. Gastroenterology 58:163–174, 1970

    Google Scholar 

  3. Behar J, Sheahan D: Histologic abnormalities in reflux esophagitis. Arch Pathol 99:387–391, 1975

    Google Scholar 

  4. Johnson L, DeMeester T, Haggitt R: Esophageal epithelial response to gastroesophageal reflux. Am J Dig Dis 23:498–509, 1978

    Google Scholar 

  5. Ismail-Beigi F, Pope C: Distribution of histologic changes in gastroesophageal reflux in the distal esophagus of man. Gastroenterology 66:1109–1113, 1974

    Google Scholar 

  6. Thomas E, Hislop IG, Grant AK: Experience with the Olympus esophagoscope: A correlation of radiologic and endoscopic findings. Am J Dig Dis 17:43–48, 1972

    Google Scholar 

  7. Akdamar K, Maumus L, Ichinose H, Font R, Sparks R: Clinical analysis of reflux esophagitis in symptomatic patients. Gastrointest Endosc 19:172–173, 1973

    Google Scholar 

  8. Pope CE: Mucosal response to esophageal motor disorders. Arch Intern Med 130:544–555, 1976

    Google Scholar 

  9. Kobayashi S, Kusugai T: Endoscopic and biopsy criteria for the diagnosis of esophagitis with fiberoptic esophagoscope. Am J Dig Dis 19:345–352, 1974

    Google Scholar 

  10. Bautista A, Dehuca V: Endoscopic photography, biopsy and cytology of the esophagus and stomach. Gastroenterology 60:294, 1971

    Google Scholar 

  11. Paull A, Trier J, Dalton M, Camp R, Leob P, Goyal R: The histologic spectrum of Barrett's esophagus. N Engl J med 295:476–480, 1976

    Google Scholar 

  12. Haggit RC, Tryzellar J, Ellis FH, Colcher H: Adenocarcinoma complicating columnar epithelium-lined (Barrett's) esophagus. Am J Clin Pathol 70:1–5, 1978

    Google Scholar 

  13. Richter JE, Pandol SJ, Castell DO, McCarthy DM: Gastroesophageal reflux disease in the Zollinger-Ellison syndrome. Ann Intern Med 95:37–43, 1981

    Google Scholar 

  14. Affolter A: Pressure characteristics of reflux esophagitis. Helv Med Acta 33:395–402, 1967

    Google Scholar 

  15. Olsen AM, Schlegel JF: Motility disturbances caused by esophagilis. J Thor Cardiovasac Surg 50:607–612, 1965

    Google Scholar 

  16. Ramirez JD, Guarner U, Pazminof F: Alterations in motility of the esophagus in peptic esophagitis. Am J Proctol 19:67–73, 1968

    Google Scholar 

  17. Henderson RD, Mugaske BA, Jeejeebhoy KN: The motor defect of esophagitis. Can J Surg 17:112–116, 1974

    Google Scholar 

  18. Miller WH, Hogan WJ, Dodds WJ, Arndorfer RC, Stef JJ: A comparison investigation of patients with symtoms of gastroesophageal reflux. Gastroenterology 66:747A, 1974

    Google Scholar 

  19. Corazza SM, Gerhardt DC, Castell DO: Altered peristalsis in symptomatic gastroesophageal reflux. Clin Res 26:759A, 1978

    Google Scholar 

  20. Burbige EJ, Radigan JI: Characteristics of the columnar-cell lined (Barrett's) esophagus. Gastrointest Endosc 25:133–136, 1979

    Google Scholar 

  21. Wesdrop ICE, Bartelsman J, Schipper MEI, Tytgat GN: Effect of long-term treatment with cimetidine and antacids in Barrett's esophagus. Gut 22:724–727, 1981

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy or the Department of Defense.

The research reported herein was supported in part by Clinical Investigation Program # 0-06-1398.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Knuff, T.E., Benjamin, S.B., Worsham, G.F. et al. Histologic evaluation of chronic gastroesophageal reflux. Digest Dis Sci 29, 194–201 (1984). https://doi.org/10.1007/BF01296251

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01296251

Keywords

Navigation