Système gastro-intestinal et digestif

Abstrait

The Status of Histopathology in the Diagnosis of Gastroesophageal Reflux Disease Time for Reappraisal?

Nora I. Schneider, Cord Langner

The histological diagnosis of gastroesophageal reflux disease is generally believed to be a tool of limited value. Recent data, however, indicate that histology may be useful for the management of patients with non-erosive reflux disease, who account for up to 60% of all patients with reflux symptoms. Early diagnosis of gastroesophageal reflux disease is crucial because chronic reflux esophagitis is a key risk factor for the development of Barrett´s esophagus, which predisposes to esophageal adenocarcinoma. Histologically, reflux esophagitis is characterized by basal cell hyperplasia, papillary elongation, dilation of intercellular spaces, and inflammatory infiltration. These reflux-induced changes of the squamous epithelium are mainly related to the diagnosis of acute and/or active reflux. The chronic consequences of gastroesophageal reflux disease are mainly characterized by metaplatic mucosal replacement. The origin and significance of cardiac mucosa at the gastroesophageal junction are still controversial However, evidence is accumulating that injury and repair related to gastroesophageal reflux disease contribute to its development and/or expansion. Multilayered epithelium, defined as hybrid epithelium with characteristics of both squamous and columnar epithelium has been identified as a new sensitive marker of gastroesophageal reflux disease. This epithelium may be the precursor of metaplastic cardiac mucosa, and ultimately Barrett’s esophagus.