In the Journals

Epithelial thickness a reliable histologic marker for GERD

Total epithelial thickness was a robust histologic marker for GERD, according to a post hoc analysis of data from the Diamond study.

“Precise definitions for histological criteria, including basal cell hyperplasia and papillary elongation, were developed and refined by an international working group,” the researchers wrote. “The aim of the current analysis was to evaluate the accuracy of these criteria for the diagnosis of GERD, as defined by endoscopy and pH monitoring, and to measure inter-assessor agreement on histological criteria.”

The researchers assessed histological markers using lower esophageal biopsies collected from 336 European and Canadian adult participants in the Diamond study, all of whom had frequent upper gastrointestinal symptoms and had not taken a proton pump inhibitor in the 2 months prior to enrollment. All patients underwent standard upper endoscopy, biopsies were taken from 0.5 cm and 2 cm above the Z-line and pH monitoring was performed afterward. They were then diagnosed as having GERD (59%), non-erosive reflux disease (NERD) or neither.

For the post hoc analysis, biopsies were independently analyzed at two pathology centers in Germany and Italy and accuracy of histologic criteria for diagnosing GERD and inter-assessor agreement on these criteria served as primary outcomes.

Based on recent consensus guidelines, the histologic variables evaluated were total epithelial thickness, basal cell layer thickness and papillary length, presence of dilated intercellular spaces and number of inflammatory cells.

The researchers found that total epithelial thickness at the assessment site for basal cell layer thickness at both 0.5 cm and 2 cm above the Z-line performed best for diagnosing GERD, and also detected non-erosive reflux disease, reflux esophagitis and pathologic esophageal acid exposure. Conversely, basal cell layer thickness and the presence of dilated intercellular spaces were not predictive of GERD. Assessments of total epithelial thickness also showed the highest inter-assessor agreement.

“Total epithelial thickness in the non-eroded distal esophagus was found to be a robust histological marker for investigation-defined GERD that has the potential for clinical applicability both in and outside of specialist centers,” the researchers concluded. “This parameter may prove useful as a surrogate marker of esophageal injury related to GERD, allowing identification of patients with [NERD] and assessment of efficacy of treatments in this patient group.” – by Adam Leitenberger

Disclosures: Vieth reports he has received consultancy fees from AstraZeneca, Falk, Pentax, Olympus, Malesci, Covidien and Shire. Please see the full study for a list of all other researchers’ relevant financial disclosures.

Total epithelial thickness was a robust histologic marker for GERD, according to a post hoc analysis of data from the Diamond study.

“Precise definitions for histological criteria, including basal cell hyperplasia and papillary elongation, were developed and refined by an international working group,” the researchers wrote. “The aim of the current analysis was to evaluate the accuracy of these criteria for the diagnosis of GERD, as defined by endoscopy and pH monitoring, and to measure inter-assessor agreement on histological criteria.”

The researchers assessed histological markers using lower esophageal biopsies collected from 336 European and Canadian adult participants in the Diamond study, all of whom had frequent upper gastrointestinal symptoms and had not taken a proton pump inhibitor in the 2 months prior to enrollment. All patients underwent standard upper endoscopy, biopsies were taken from 0.5 cm and 2 cm above the Z-line and pH monitoring was performed afterward. They were then diagnosed as having GERD (59%), non-erosive reflux disease (NERD) or neither.

For the post hoc analysis, biopsies were independently analyzed at two pathology centers in Germany and Italy and accuracy of histologic criteria for diagnosing GERD and inter-assessor agreement on these criteria served as primary outcomes.

Based on recent consensus guidelines, the histologic variables evaluated were total epithelial thickness, basal cell layer thickness and papillary length, presence of dilated intercellular spaces and number of inflammatory cells.

The researchers found that total epithelial thickness at the assessment site for basal cell layer thickness at both 0.5 cm and 2 cm above the Z-line performed best for diagnosing GERD, and also detected non-erosive reflux disease, reflux esophagitis and pathologic esophageal acid exposure. Conversely, basal cell layer thickness and the presence of dilated intercellular spaces were not predictive of GERD. Assessments of total epithelial thickness also showed the highest inter-assessor agreement.

“Total epithelial thickness in the non-eroded distal esophagus was found to be a robust histological marker for investigation-defined GERD that has the potential for clinical applicability both in and outside of specialist centers,” the researchers concluded. “This parameter may prove useful as a surrogate marker of esophageal injury related to GERD, allowing identification of patients with [NERD] and assessment of efficacy of treatments in this patient group.” – by Adam Leitenberger

Disclosures: Vieth reports he has received consultancy fees from AstraZeneca, Falk, Pentax, Olympus, Malesci, Covidien and Shire. Please see the full study for a list of all other researchers’ relevant financial disclosures.