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

  • Original Article—Alimentary Tract
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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.

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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

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The authors declare that they have no conflicts of interest.

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Correspondence to Edoardo Savarino.

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Savarino, E., Zentilin, P., Mastracci, L. et al. Microscopic esophagitis distinguishes patients with non-erosive reflux disease from those with functional heartburn. J Gastroenterol 48, 473–482 (2013). https://doi.org/10.1007/s00535-012-0672-2

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  • DOI: https://doi.org/10.1007/s00535-012-0672-2

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