To assess the relationship between acid reflux and histological damage of the oesophageal mucosa.Design:
In the assessment of gastro-oesophageal reflux disease, there is a poor correlation between the presence of endoscopic oesophagitis and abnormal oesophageal acid exposure as measured by oesophageal pH monitoring. Assessment of oesophagitis by histology provides a more objective examination of the relationship between oesophageal acid exposure and mucosal damage. In this study, the results of oesophageal pH monitoring and histological assessment of the oesophageal mucosa were compared in 73 patients, presenting to their local hospital for the first time with heartburn.Methods:
Endoscopic findings, histological variables and results of pH monitoring were each recorded by authors blinded to the results of the other two measures.Results:
Oesophageal acid exposure was significantly higher in patients with histological oesophagitis (total time pH<4: 6.6 compared with 3.5%, P <0.05). However, when individual histological parameters were examined, the most specific (basal zone hyperplasia and papillary elongation, 80% specificity) were insensitive (<35%) for abnormal oesophageal acid exposure. Neutrophil infiltration was more sensitive (63%), but relatively non-specific (56%).Conclusion:
The value of histology in the assessment of reflux disease appears to be limited.