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Journal of Gastroenterology

, Volume 48, Issue 4, pp 473–482 | Cite as

Microscopic esophagitis distinguishes patients with non-erosive reflux disease from those with functional heartburn

  • Edoardo SavarinoEmail author
  • Patrizia Zentilin
  • Luca Mastracci
  • Pietro Dulbecco
  • Elisa Marabotto
  • Lorenzo Gemignani
  • Luca Bruzzone
  • Nicola de Bortoli
  • Anna Chiara Frigo
  • Roberto Fiocca
  • Vincenzo Savarino
Original Article—Alimentary Tract

Abstract

Background

Microscopic esophagitis (ME) is common in patients with non-erosive reflux disease (NERD), and dilation of intercellular spaces (DIS) has been regarded as the potential main mechanism of symptom generation. We aimed to compare these histological abnormalities in healthy volunteers (HVs) and patients with erosive esophagitis (EE), NERD, and functional heartburn (FH).

Methods

Consecutive patients with heartburn prospectively underwent upper endoscopy and impedance-pH off-therapy. Twenty EE patients and fifty-seven endoscopy-negative patients (NERD), subclassified as 22 with pH-POS (positive for abnormal acid exposure), 20 with hypersensitive esophagus (HE; normal acid/symptom association probability [SAP]+ or symptom index [SI]+), and 15 with FH (normal acid/SAP-/SI-/ proton pump inhibitor [PPI] test-), were enrolled. Twenty HVs were also included. In each patient/control, multiple specimens (n = 5) were taken from the distal esophagus and histological alterations were evaluated. ME was diagnosed when the global histological score was >0.35.

Results

The prevalence of ME was higher (p < 0.0001) in EE (95 %), pH-POS (77 %), and HE (65 %) NERD patients than in FH patients (13 %) and HVs (15 %). Also, basal cell hyperplasia (p < 0.0023), DIS (p < 0.0001), and papillae elongation (p < 0.0002) showed similar rates of prevalence in the above populations (p < 0.0001). ME, including each histological lesion, had similar low frequencies in FH and HVs (p = 0.9990). Considering the histological abnormalities together, they permitted us to clearly differentiate EE and NERD from FH and HVs (p < 0.0001 and p < 0.0001, respectively).

Conclusions

The lack of ME in the esophageal distal biopsies of FH patients indicates a limited role of these histological abnormalities in symptom generation in them. ME can be considered as an accurate and reliable diagnostic marker for distinguishing FH patients from GERD patients and has the potential to be used to guide the correct therapy.

Keywords

Dilated intercellular spaces Gastroesophageal reflux Functional heartburn NERD 

Abbreviations

ME

Microscopic esophagitis

DIS

Dilation of intercellular spaces

NERD

Non-erosive reflux disease

EE

Erosive esophagitis

HVs

Healthy volunteers

FH

Functional heartburn

HE

Hypersensitive esophagus

SAP

Symptom association probability

SI

Symptom index

PPI

Proton pump inhibitor

GERD

Gastroesophageal reflux disease

TEM

Transmission electron microscopy

LM

Light microscopy

SCJ

Squamocolumnar junction

BCH

Basal cell hyperplasia

PE

Papillae elongation

GS

Global score

AET

Acid exposure time

GEE

Generalized estimating equations

LES

Lower esophageal sphincter

Notes

Conflict of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Springer 2012

Authors and Affiliations

  • Edoardo Savarino
    • 1
    Email author
  • Patrizia Zentilin
    • 2
  • Luca Mastracci
    • 3
  • Pietro Dulbecco
    • 2
  • Elisa Marabotto
    • 2
  • Lorenzo Gemignani
    • 2
  • Luca Bruzzone
    • 2
  • Nicola de Bortoli
    • 4
  • Anna Chiara Frigo
    • 5
  • Roberto Fiocca
    • 3
  • Vincenzo Savarino
    • 2
  1. 1.Gastroenterology Unit, Department of Surgical, Oncological and Gastroenterological SciencesUniversity of PaduaPaduaItaly
  2. 2.Division of Gastroenterology, Department of Internal MedicineIRCCS AOU San Martino, ISTGenoaItaly
  3. 3.Dipartimento di Discipline ChirurgicheMorfologiche E Metodologie Integrate, University of GenoaGenoaItaly
  4. 4.Gastroenterology Unit, Department of Internal MedicineUniversity of PisaPisaItaly
  5. 5.Department of Cardiac, Thoracic and Vascular SciencesUniversity of PaduaPaduaItaly

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