Validation study of the Esohisto consensus guidelines for the recognition of microscopic esophagitis (histoGERD Trial)

Schneider, Nora; Plieschnegger, Wolfgang; Geppert, Michael; Wigginghaus, Bernd; Hoess, Gabriele M.; Eherer, Andreas; Wolf, Eugene M.; Rehak, Peter; Vieth, Michael; Langner, Cord

doi:10.1016/j.humpath.2013.12.013

Cited by 52 publications

(44 citation statements)

References 26 publications

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“…Overall, the prevalence of microscopic esophagitis in our cohort (20%) is similar to that previously published in adult studies. 33–35 However, adult studies have found differences in microscopic esophagitis between reflux phenotypes, with the highest rates of esophagitis in patients with NERD and the lowest rates in patients with functional heartburn. 34 There is only a single pediatric study assessing the role of esophagitis in reflux phenotypes; Altaf et al 36 found increased esophageal epithelial intercellular spaces in children with NERD compared with controls.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Rome IV Nonerosive Esophageal Phenotypes in Children

Mahoney

Nurko

Rosen

2017

The Journal of Pediatrics

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Objectives To assess the prevalence of Rome IV nonerosive esophageal phenotypes in children using multichannel intraluminal impedance testing and to describe the rates of proton pump inhibitor (PPI) responsiveness and the frequency of microscopic esophagitis in these patients. Study design We conducted a retrospective review of all children ≥5 years of age who underwent esophagogastroduodenoscopy and multichannel intraluminal impedance testing off PPI therapy for evaluation of typical gastroesophageal reflux symptoms. Only children with symptoms during the multichannel intraluminal impedance testing were included. Children were categorized into the following nonerosive esophageal phenotypes using Rome IV criteria: nonerosive reflux disease, reflux hypersensitivity, and functional heartburn. Rates of esophagitis and responsiveness to acid suppression therapy were assessed. Results Forty-five children were included: 27% were categorized as having nonerosive reflux disease, 29% with reflux hypersensitivity (27% acid and 2% nonacid), and 44% with functional heartburn. Older children reported significantly more heartburn (P < .001) than younger children, whereas younger children were more likely to report nonspecific pain (P = .047). There were no differences between groups in other reflux symptoms, rates of responsiveness to PPIs, or the presence of microscopic esophagitis on biopsy. Conclusions Functional heartburn is the most common Rome IV nonerosive esophageal phenotype in children. Neither microscopic esophagitis nor PPI responsiveness can predict phenotype in pediatric patients.

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Section: Discussionmentioning

confidence: 99%

The Prevalence of Rome IV Nonerosive Esophageal Phenotypes in Children

Mahoney

Nurko

Rosen

2017

The Journal of Pediatrics

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“…Eosinophilic esophagitis was defined as greater than 15 intraepithelial eosinophils per high power field with eosinophil microabscesses. Reactive changes within the squamous epithelium that have been associated with inflammation and gastroesophageal reflux disease, specifically elongation of papillae and basal cell hyperplasia, 7 were also evaluated.…”

Section: Histologic Evaluationmentioning

confidence: 99%

Post-ablation lymphocytic esophagitis in Barrett esophagus with high grade dysplasia or intramucosal carcinoma

et al. 2016

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In patients who have undergone ablation therapy for treatment of Barrett's esophagus with dysplasia, histologic features of eosinophilic esophagitis, but not lymphocytic esophagitis, have been described. We evaluated for histologic evidence of eosinophilic esophagitis and lymphocytic esophagitis and correlated with endoscopic findings in this population. A single-institution Barrett's esophagus registry was searched for patients who had received radiofrequency ablation, cryotherapy, or both for treatment of Barrett's esophagus with dysplasia. Clinical and endoscopic data were collected and biopsies were reviewed for inflammation and reactive changes at three time points: pre-intervention, first surveillance after ablation therapy, and most recent surveillance. Of the 173 patients initially identified, 102 met the inclusion criteria. Intraepithelial eosinophils were increased at first surveillance (60%, P = 0.096) and last surveillance (69%, P = 0.048) compared with pre-intervention (50%), although histologic evidence of post-ablation eosinophilic esophagitis was not significant. Prevalence of lymphocytic esophagitis was significantly higher at first surveillance (17%, P = 0.02) and at last surveillance (43%, Po 0.001), compared with pre-intervention (7%). Smoking, hyperlipidemia, and cryotherapy were identified as independent risk factors for developing histologic lymphocytic esophagitis. This is the first report that histologic evidence of lymphocytic esophagitis increased over time in patients undergoing ablation for Barrett's esophagus with dysplasia. Though the pathophysiology of lymphocytic esophagitis remains unknown, patients in our study with a history of smoking, hyperlipidemia, or cryotherapy were more likely to develop post-ablation lymphocytic esophagitis.

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“…It was found that only intraepithelial T lymphocytes correlated with the histological lesions both in reflux oesophagitis and non‐erosive disease; the other cell types had a limited role in GERD. However, concern has been raised regarding the relevance of these morphological changes . Even if available morphological data on the squamous epithelium currently have little practical impact on the management of GERD, they may well influence our understanding of the pathogenesis of GERD and its chronic, progressive and relapsing nature.…”

Section: Introductionmentioning

confidence: 99%

“…However, concern has been raised regarding the relevance of these morphological changes. [13][14][15][16] Even if available morphological data on the squamous epithelium currently have little practical impact on the management of GERD, they may well influence our understanding of the pathogenesis of GERD and its chronic, progressive and relapsing nature.…”

Section: Introductionmentioning

confidence: 99%