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

Journal of Gastroenterology

Volumn 48, Issue 4, 2013, Pages 473-482

  Savarino, Edoardo ^a   Zentilin, Patrizia ^b   Mastracci, Luca ^c   Dulbecco, Pietro ^b   Marabotto, Elisa ^b   Gemignani, Lorenzo ^b   Bruzzone, Luca ^b   De Bortoli, Nicola ^d   Frigo, Anna Chiara ^a   Fiocca, Roberto ^c   Savarino, Vincenzo ^b  

^a UNIVERSITY OF PADOVA   (Italy)

^b UNIVERSITY OF GENOA   (Italy)

^c UNIVERSITY OF GENOA   (Italy)

^d UNIVERSITY OF PISA   (Italy)

Author keywords

Dilated intercellular spaces; Functional heartburn; Gastroesophageal reflux; NERD

Indexed keywords

ADULT; AGED; ARTICLE; BASAL CELL; CELL HYPERPLASIA; COMPARATIVE STUDY; CONTROLLED STUDY; DIAGNOSTIC TEST ACCURACY STUDY; DIAGNOSTIC VALUE; ENDOSCOPY; ESOPHAGITIS; FEMALE; FUNCTIONAL HEARTBURN; HEARTBURN; HISTOLOGY; HUMAN; MAJOR CLINICAL STUDY; MALE; MICROSCOPIC ESOPHAGITIS; MIDDLE AGED; NON EROSIVE REFLUX DISEASE; PREVALENCE; PRIORITY JOURNAL; PUMP; SCORING SYSTEM; SINGLE BLIND PROCEDURE; YOUNG ADULT; BIOPSY; CASE CONTROL STUDY; DIFFERENTIAL DIAGNOSIS; ESOPHAGEAL PH MONITORING; ESOPHAGUS; GASTROESOPHAGEAL REFLUX; GASTROINTESTINAL ENDOSCOPY; IMPEDANCE; METHODOLOGY; PATHOLOGY; PATHOPHYSIOLOGY; PROSPECTIVE STUDY; REFLUX ESOPHAGITIS;

ADULT; AGED; BIOPSY; CASE-CONTROL STUDIES; DIAGNOSIS, DIFFERENTIAL; ELECTRIC IMPEDANCE; ENDOSCOPY, GASTROINTESTINAL; ESOPHAGEAL PH MONITORING; ESOPHAGITIS; ESOPHAGITIS, PEPTIC; ESOPHAGUS; FEMALE; GASTROESOPHAGEAL REFLUX; HEARTBURN; HUMANS; MALE; MIDDLE AGED; PROSPECTIVE STUDIES; YOUNG ADULT;

EID: 84877053481     PISSN: 09441174     EISSN: 14355922     Source Type: Journal    
DOI: 10.1007/s00535-012-0672-2     Document Type: Article

References (31)

1. Dent J. Microscopic esophageal mucosal injury in nonerosive reflux disease. Clin Gastroenterol Hepatol. 2007;5: 4-16.
2. Tobey NA, Carson JL, Alkiek RA, Orlando RC. Dilated intercellular spaces: a morphological feature of acid-reflux damaged human esophageal epithelium. Gastroenterology. 1996;111: 1200-5.
3. Calabrese C, Fabbri A, Bortolotti M, Cenacchi G, Areni A, Scialpi C, et al. Dilated intercellular spaces as a marker of oesophageal damage: comparative results in gastro-esophageal reflux disease with or without bile reflux. Aliment Pharmacol Ther. 2003;18: 525-32.
4. Caviglia R, Ribolsi M, Maggiano N, Gabbrielli AM, Emerenziani S, Guarino MP, et al. Dilated intercellular spaces of esophageal epithelium in non erosive reflux disease patients with physiological esophageal acid exposure. Am J Gastroenterol. 2005;100: 543-8.
5. Villanacci V, Grigolato PG, Cestari R, Missale G, Cengia G, Klersy C, et al. Dilated intercellular spaces as marker of esophageal reflux: histology, semi-quantitative score and morphometry upon light microscopy. Digestion. 2001;64: 1-8.
6. Zentilin P, Savarino V, Mastracci L, Spaggiari P, Dulbecco P, Ceppa P, et al. Reassessment of the diagnostic value of histology in patients with GERD, using multiple biopsy sites and an appropriate control group. Am J Gastroenterol. 2005;100: 2299-306.
7. van Malestein H, Farrè R, Sifrim D. Esophageal dilated intercellular spaces (DIS) and nonerosive reflux disease. Am J Gastroenterol. 2007;102: 1-8.
8. Savarino E, Zentilin P, Tutuian R, Pohl D, Casa DD, Frazzoni M, et al. The role of non-acid reflux in NERD: lessons learned from impedance-pH monitoring in 150 patients off therapy. Am J Gastroenterol. 2008;103: 2685-93.
9. Galmiche JP, Clouse RE, Bàlint A, Cook IJ, Kahrilas PJ, Paterson WG, et al. Functional esophageal disorders. Gastroenterology. 2006;130: 1459-65.
10. Frazzoni M, Conigliaro R, Mirante VG, Melotti G. The added value of quantitative analysis of on-therapy impedance-pH parameters in distinguishing refractory non-erosive reflux disease from functional heartburn. Neurogastroenterol Motil. 2011. doi: 10.1111/j.1365-2982.2011.01800.x.
11. Savarino E, Pohl D, Zentilin P, Dulbecco P, Sammito G, Sconfienza L, et al. Functional heartburn has more in common with functional dyspepsia than with non-erosive reflux disease. Gut. 2009;58: 1185-91.
12. Carlsson R, Dent J, Bolling-Sternevald E, Johnsson F, Junghard O, Lauritsen K, et al. The usefulness of a structured questionnaire in the assessment of symptomatic gastroesophageal reflux disease. Scand J Gastroenterol. 1998;33: 1023-9.
13. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45: 172-80.
14. Vakil N, van Zanten SV, Kahrilas P, Dent J. Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101: 1900-20.
15. Yerian L, Fiocca R, Mastracci L, et al. Refinement and reproducibility of histologic criteria for the assessment of microscopic lesions in patients with gastroesophageal reflux disease: the Esohisto Project. Dig Dis Sci. 2011;56(9): 2656-65.
16. Fiocca R, Mastracci L, Riddell R, et al. Development of consensus guidelines for the histologic recognition of microscopic esophagitis in patients with gastroesophageal reflux disease: the Esohisto project. Hum Pathol. 2010;41(2): 223-31.
17. Mastracci L, Spaggiari P, Grillo F, Zentilin P, Dulbecco P, Ceppa P, et al. Microscopic esophagitis in gastroesophageal reflux disease: individual lesions, biopsy sampling, and clinical correlations. Virchows Arch. 2009;454: 31-9.
18. Savarino E, Tutuian R, Zentilin P, Dulbecco P, Pohl D, Marabotto E, et al. Characteristics of reflux episodes and symptom association in patients with erosive esophagitis and nonerosive reflux disease: study using combined impedance-pH off therapy. Am J Gastroenterol. 2010;105: 1053-61.
19. Zentilin P, Iiritano E, Dulbecco P, Bilardi C, Savarino E, De Conca S, et al. Normal values of 24-h ambulatory intraluminal impedance combined with pH-metry in subjects eating a Mediterranean diet. Dig Liver Dis. 2006;38: 226-32.
20. Bredenoord AJ, Weusten BL, Smout AJ. Symptom association analysis in ambulatory gastro-oesophageal reflux monitoring. Gut. 2005;54: 1810-7.
21. Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO. Simultaneous intraesophageal impedance and pH measurement of acid and non-acid gastroesophageal reflux : effect of omeprazole. Gastroenterology. 2001;120: 1599-606.
22. Slaughter JC, Goutte M, Rymer JA, Oranu AC, Schneider JA, Garrett CG, et al. Caution about overinterpretation of symptom indexes in reflux monitoring for refractory gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2011;9(10): 868-74.
23. Smout AJPM. Review article: the measurement of non-acid gastro-oesophageal reflux. Aliment Pharmacol Ther. 2007; 26(Suppl 2): 7-12.
24. Viazis N, Keyoglou A, Kanellopoulos AK, Karamanolis G, Vlachogiannakos J, Triantafyllou K, et al. Selective serotonin reuptake inhibitors for the treatment of hypersensitive esophagus: a randomized, double-blind, placebo-controlled study. Am J Gastroenterol. 2011 (Epub ahead of print).
25. Savarino E, Marabotto E, Zentilin P, Frazzoni M, Sammito G, Bonfanti D, et al. The added value of impedance-pH monitoring to Rome III criteria in distinguishing functional heartburn from non-erosive reflux disease. Dig Liver Dis. 2011;43(7): 542-7.
26. Farré R, Fornari F, Blondeau K, Vieth M, De Vos R, Bisschops R, et al. Acid and weakly acidic solutions impair mucosal integrity of distal exposed and proximal non-exposed human oesophagus. Gut. 2010;59: 164-9.
27. Farrè R, De Vos R, Geboes K, Vanden Berghe P, Depoortere I, Blondeau K, et al. Critical role of stress in increased oesophageal mucosa permeability and dilated intercellular spaces. Gut. 2007;56: 1191-7.
28. Fiocca R, Mastracci L, Engström C, Attwood S, Ell C, Galmiche JP, et al. Long-term outcome of microscopic esophagitis in chronic GERD patients treated with esomeprazole or laparoscopic antireflux surgery in the LOTUS trial. Am J Gastroenterol. 2010;105: 1015-23.
29. Vela MF, Craft BM, Sharma N, Freeman J, Hazen-Martin D. Refractory heartburn: comparison of intercellular space diameter in documented GERD vs functional heartburn. Am J Gastroenterol. 2011;106(5): 844-50.
30. Savarino E, Zentilin P, Tutuian R, Pohl D, Gemignani L, Malesci A, et al. Impedance-pH reflux patterns can differentiate nonerosive reflux disease from functional heartburn patients. J Gastroenterol. 2012;47(2): 159-68.
31. Calabrese C, Bortolotti M, Fabbri A, Areni A, Cenacchi G, Scialpi C, et al. Reversibility of GERD ultrastructural alterations and relief of symptoms after omeprazole treatment. Am J Gastroenterol. 2005;100: 537-42.