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The contribution of intraepithelial inflammatory cells to the histological diagnosis of microscopic esophagitis

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Abstract

Background

Diagnosis of gastro-esophageal reflux disease (GERD) is mainly based on symptom evaluation, possibly coupled with various invasive investigations (endoscopy, pH-metry, and impedance). New input has recently come from histology: in this context, the diagnostic role of inflammatory cells other than eosinophils and neutrophils is still debated. Aim of the study is to evaluate the diagnostic relevance of intraepithelial lymphocytes, mast cells, and Langerhans cells in GERD-associated microscopic esophagitis (GAME).

Methods

Twenty healthy volunteers and 119 patients with GERD symptoms were prospectively recruited and subdivided, on the basis of endoscopy and pH-metry, in erosive (ERD, 48) and non-erosive disease (NERD, 71). Biopsy samples at 2 cm above the Z-line and at Z-line were evaluated for GERD-associated histological lesions (basal cell hyperplasia, papillae elongation, intercellular space dilatation, intraepithelial eosinophils, and neutrophils). Immunohistochemistry for T lymphocytes (CD3, CD4, CD8), B lymphocytes (CD20), NK cells (CD56), macrophages (CD68), mast cells (c-Kit), and Langerhans cells (S100) was performed.

Results

Among inflammatory cells, only intraepithelial T lymphocytes (ITLs) showed statistical correlation with the other histological lesions both in ERD and NERD. ITLs distinguished GERD patients from controls with good sensitivity and specificity (85.5 and 85 % at 2 cm above Z-line; 89.5 and 75 % at Z-line) when a cut-off of 20 cells was applied. An analysis of the T subpopulations found a CD4+/CD8+ ratio close to 1:1; B cells, mast cells, Langerhans cells, NK cells, and macrophages showed a limited role in GERD.

Conclusions

ITL evaluation represents an additional useful parameter in the histological evaluation of GAME.

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Acknowledgments

We thank Simona Pigozzi and Silvia Bonadio for technical support and Sonia Massa and Margherita Colombara for secretarial support.

Statement of Human Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

Conflict of interest

Luca Mastracci, Martina Bruzzone, Elena Pacella, Carmine Tinelli, Patrizia Zentilin, Edoardo Savarino, Annalisa De Silvestri, Roberto Fiocca, and Federica Grillo declare that they have no conflict of interest.

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Authors and Affiliations

  1. Pathology Unit, Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy

    Luca Mastracci, Martina Bruzzone, Elena Pacella, Roberto Fiocca & Federica Grillo

  2. IRCCS S. Martino-IST, Genoa, Italy

    Luca Mastracci, Martina Bruzzone, Elena Pacella, Patrizia Zentilin, Roberto Fiocca & Federica Grillo

  3. Clinical Epidemiology and Biometric Unit, Foundation IRCCS Policlinico S. Matteo, Pavia, Italy

    Carmine Tinelli & Annalisa De Silvestri

  4. Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy

    Patrizia Zentilin

  5. Gastroenterology Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy

    Edoardo Savarino

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  1. Luca Mastracci
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  2. Martina Bruzzone
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Correspondence to Luca Mastracci.

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Mastracci, L., Bruzzone, M., Pacella, E. et al. The contribution of intraepithelial inflammatory cells to the histological diagnosis of microscopic esophagitis. Esophagus 13, 80–87 (2016). https://doi.org/10.1007/s10388-015-0501-9

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  • DOI: https://doi.org/10.1007/s10388-015-0501-9

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