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Excerpt
Methods: A retrospective database analysis of 34 children with the clinical suspicion of GERD underwent evaluation by EPHM and upper endoscopy with biopsy. Of the 34 patients, 7 were excluded from the analysis because of a diagnosis of eosinophilic esophagitis and gastroenteritis. GERD was defined by a reflux index (RI) > = 10% (<1 yr. of age), 7% (>= 1yr. of age), based on the 95th percentile of RI for age. One pathologist reviewed all the biopsy slides blinded to the clinical findings. The histologic criteria considered were: basal zone thickening (BZT)(>16%), papillary zone elongation (PZE) (>67%), balloon cell change (BCC), RBC lakes and intraepithelial leukocytes (>=1–2/HPF). The Fisher’s exact test (one tail) was used for statistical analysis.
Results: Of the 27 patients who underwent EPHM, 9 received the diagnosis of GERD. PZE was found in 4/9 GERD pts and 1/18 without GERD (p<0.03). BCC was present in 9/9 GERD pts and 13/18 without GERD. The combination of PZE and BCC was found in 4/9 GERD pts and 0/18 without GERD (p<0.01). Non-specific findings included BZT, intraepithelial lymphocytes and RBC lakes. Significant infiltration of neutrophils was seen only in a single case (GERD pt), and only two cases demonstrated significant eosinophilic infiltrates (1 GERD, 1 non-GERD).
Conclusion: In this analysis, a significant correlation was found between EPHM confirmed GERD and the histologic findings of PZE and BCC. PZE was highly specific, and when used in combination with BCC was absolutely diagnostic. Larger prospective clinical studies are required to determine the predictive value of histopathology in relation to EPHM confirmed GERD.
