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Histopathology of the endoscopic esophagogastric junction in patients with gastroesophageal reflux disease

Histopathologie des endoskopisch sichtbaren ösophagogastralen Übergangs bei Patienten/Innen mit gastroösophagealer Refluxkrankheit

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Zusammenfassung

HINTERGRUND: Unklar ist, ob der Beginn der endoskopischen Magenfalten auch dem anatomischen ösphagogastralen Übergang entspricht. Wir haben Endoskopie und Histopathologie des ösophagogastralen Übergangs bei Patienten mit gastroösophagealer Refluxkrankheit (GERD) verglichen. METHODIK: Bei 102 Personen (60 Frauen) mit GERD wurden Endoskopie und multi Level Biopsien vom Beginn der Magenfalten (= level 0), 0,5, 1,0 cm distal und 0,5, ≥ 1 cm proximal davon durchgeführt. Zylinderepithel-Ösophagus (columnar lined esophagus = CLE) wurde entsprechend der Paull Chandrasoma Klassifikation, die Ösophagitis nach der Los Angeles Klassifikation befundet. Hiatus Hernie lag vor, wenn die Magenfalten ≥ 2 cm über dem Zwerchfell-Niveau begannen, die ösophagogastrische Klappe wurde entsprechend der Hill Klassifikation beurteilt. ERGEBNISSE: Alle Personen hatten CLE, maximal am Level 0 (97%), mit nach proximal und distal abnehmender Häufigkeit (81%, 28%, 40% and 18% bei Biopsielevel −0,5, −1,0, + 0,5, bzw. + 1,0 cm). Histopathologischer CLE (= Distanz zwischen CLE positiven Biopsie Levels) war länger als endoskopischer CLE (p < 0,001). Alle 19 Personen mit intestinaler Metaplasie (18,6%) wurden durch 4-Quadranten Biopsien vom Platten-Zylinderepithel Übergang und 0,5 cm distal davon identifiziert. Jene mit intestinaler Metaplasie waren älter, hatten häufiger eine Hernie, höheren Hill Grad und endoskopisch sichtbaren CLE (p < 0,05). Kein signifikanter Unterschied zeigte sich bezüglich Geschlecht, Ösophagitis und Länge von endoskopischen und histologischem CLE (p > 0,05). Dysplasie oder Karzinom lagen nicht vor. ZUSAMMENFASSUNG: Der Übergang Ösophagus – Magen kann endoskopisch nicht erhoben werden, dies gelingt durch Histopathologie von Biopsien. Die Wahrscheinlichkeit, intestinale Metaplasie zu diagnostizieren, ist in Biopsien aus der Platten-, Zylinderepithelgrenze am höchsten.

Summary

BACKGROUND: Discrepancy exists between the endoscopic (rugal folds) and the histopathologic (oxyntic mucosa) definition of proximal stomach. We compared endoscopy and histopathology of the esophagogastric junction in patients with gastroesophageal reflux disease. METHODS: A total of 102 consecutive patients (60 women) with gastroesophageal reflux disease prospectively underwent endoscopy including multilevel biopsy sampling at the level of the rise of rugal folds (level 0), and also 0.5 cm and 1.0 cm distal and 0.5 cm and ≥ 1 cm proximal to this point. Columnar lined esophagus (CLE) was cataloged according to the histopathologic Paull-Chandrasoma classification and esophagitis according to the endoscopic Los Angeles classification. Hiatal hernia was diagnosed if the endoscopic rugal folds commenced ≥ 2 cm above the diaphragm; competency of the esophagogastric valve was graded according to the Hill classification. RESULTS: All patients had histopathologic CLE with maximal presence at level 0 (97%) and a decrease towards proximal and distal biopsy levels (level −0.5 cm, 81%; level −1.0, 28%; level + 0.5 cm, 40%; level + 1.0 cm, 18%). Histopathologic CLE (distance between CLE-positive biopsy levels) was longer than endoscopic CLE (P < 0.001). All 19 patients with intestinal metaplasia (18.6%) were identified from 4-quadrant biopsies obtained at the squamocolumnar junction and at 0.5 cm distal from it. Persons with intestinal metaplasia were significantly older, had increased frequency of endoscopic hiatal hernia, higher Hill grade and presence of endoscopic CLE (P < 0.05); no significant difference was observed regarding sex, endoscopic esophagitis or length of endoscopic and histopathologic CLE (P > 0.05). None of the patients had dysplasia or carcinoma. CONCLUSIONS: In patients with gastroesophageal reflux disease the esophagogastric junction cannot be identified by endoscopy but requires histopathology of multilevel biopsies. The squamocolumnar junction harbors the highest yield of intestinal metaplasia.

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Authors and Affiliations

  1. University Clinic of Surgery, Medical University Vienna, Austria

    Claudia Ringhofer, Johannes Lenglinger, Barbara Izay, Katharina Kolarik, Johannes Zacherl, Margit Eisler, Enrico P. Cosentini, Gerhard Prager & Martin Riegler

  2. Department of Clinical Pathology, Medical University Vienna, Austria

    Fritz Wrba

  3. Department of Surgical Pathology, University of Southern California, Los Angeles, USA

    Parakrama T. Chandrasoma

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  1. Claudia Ringhofer
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  2. Johannes Lenglinger
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Correspondence to Martin Riegler.

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Ringhofer, C., Lenglinger, J., Izay, B. et al. Histopathology of the endoscopic esophagogastric junction in patients with gastroesophageal reflux disease. Wien Klin Wochenschr 120, 350–359 (2008). https://doi.org/10.1007/s00508-008-0997-2

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