Red Streaks in the Oesophagus in Patients with Reflux Disease: Is There a Histomorphological Correlate?

Vieth, Michael; Haringsma, Jelle; Delarive, J.; Wiesel, Paul; Tam, William; Tytgat, G. N. J.; Stolte, Manfred; Lundell, Lars

doi:10.1080/00365520152584725

Cited by 38 publications

(5 citation statements)

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“…Recent global consensus guidelines define reflux esophagitis as the presence of endoscopically visible breaks in the esophageal mucosa at or immediately above the gastroesophageal junction (13,50,124). Evidence from adult studies indicates that visible breaks in the esophageal mucosa are the endoscopic signs of greatest interobserver reliability (125)(126)(127). Operator experience is an important component of interobserver reliability (128,129).…”

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confidence: 99%

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Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

Vandenplas

Rudolph

Lorenzo

et al. 2009

J. pediatr. gastroenterol. nutr.

677

807

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is an expert in gastroesophageal reflux disease and aerodigestive disorders. Yvan Vandenplas MD, PhD: YV is an expert in gastroesophageal reflux disease. Maartje Singendonk MD: MS is an expert in esophageal physiology. Michael Cabana MD: MC is a pediatrician with expertise in consensus guideline Carlo Di Lorenzo MD: CD is an expert in pediatric motility disorders and gastroesophageal reflux disease Frederic Gottrand MD: FG is an expert in esophagitis and gastroesophageal reflux disease Sandeep Gupta MD: SG is an expert in esophageal diseases. Miranda Langendam PhD: ML is aguideline methodologist Annamaria Staiano MD: AS is an expert in pediatric motility disorders and gastroesophageal reflux disease. Nikhil Thapar MD: NT is an expert in pediatric motility disorders. Neelesh Tipnis MD: NT is an expert in pediatric motility disorders. Merit Tabbers MD, PhD: MT is an expert in gastroesophageal reflux disease.

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confidence: 99%

“…Operator experience is an important component of interobserver reliability (128,129). Mucosal erythema or an irregular Z-line is not a reliable sign of reflux esophagitis (126,127). Grading the severity of esophagitis, using a recognized endoscopic classification system, is useful for evaluation of the severity of esophagitis and response to treatment.…”

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confidence: 99%

Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

Vandenplas

Rudolph

Lorenzo

et al. 2009

J. pediatr. gastroenterol. nutr.

677

807

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“…Evidence for oesophageal mucosal folding resulting from a collapsed or a narrow lumen diameter is seen both during radiology and endoscopy and from the linear areas of erthyma and erosion in oesophagitis (see figure 4). In addition, these areas of erythma at the tips of the folds have been recently validated as being indicative of acid/peptic mucosal injury with correlated histomorphological changes (Vieth et al 2001). Both mucosal folding and changes in the morphology and mechanical properties of the oesophageal wall may alter the area of mucosa exposed to luminal acid content.…”

Section: Discussionmentioning

confidence: 99%

“…The estimations of EU given as examples assume uniform exposure at the level of the transducer. The evidence from oesophagitis and pathological studies shows that the exposure is non-uniform and localized as a result of the formation of folds (Vieth et al 2001). With differing regions at the same level having different exposures, a local measure of exposure is required.…”

Section: Practical Problemsmentioning

confidence: 99%

A pH-mucosa area unit of measure to consider morphology of the oesophagus when evaluating oesophagitis

et al. 2003

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Gastro-oesophageal pH measurements are routinely carried out to quantify and determine if levels of acid reflux are responsible for symptoms. Although considered the 'gold standard', evidence suggests that pH measurements do not correlate well with the degree of oesophagitis seen during endoscopy. In this study the current measure of pH was critically examined taking into account both the effects of changes in luminal diameter and endoscopy observations. The oesophageal lumen diameter was investigated using a barium swallow for 25 patients presenting with oesophageal disorders. For each subject the widest luminal diameter was measured for a series of five controlled swallows. The results showed that the lumen diameter varied widely from 0.9 to 3.8 cm. An alternative approach to the current measurement of pH was explored. In this approach the exposure not only included the luminal pH and time exposed but also the area of mucosa exposed as a result of differing luminal diameters. Although it is currently not possible to assess the diameter or morphology of the oesophageal lumen during a pH study, the analysis highlighted that the current measure of pH exposure time does not include the area of mucosa exposed. These results may explain, to some extent, the poor correlation between pH measurements and degree of oesophagitis seen during endoscopy.

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“…3). Therefore, the biopsy site and the notion that histological changes might be just one stage in the dynamics of epithelial damage and healing might be very important [17]. …”

Section: Histology In Gerdmentioning

confidence: 99%

Structural Abnormalities of Endoscopy-Negative Reflux Disease – Real or Perceived?

Vieth

2008

Digestion

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About two thirds of individuals affected by gastroesophageal reflux disease suffer from endoscopy-negative esophageal reflux disease. Often, these individuals do not receive adequate medication. In contrast, erosive reflux disease is much better defined and even subclassified as mucosal breaks of the esophageal epithelium. It is known from large trials that gastroesophageal reflux disease is probably not a categorical disease without further progression. On the other hand, the first structural changes of the esophageal epithelium indicating the beginning of reflux disease are unknown. Furthermore, it is not known when reflux esophagitis is structurally healed (besides symptom relief). Histological markers are based on observations made without clinical correlation. It has gradually become clear that there are no specific reflux-induced esophageal lesions. All described histological criteria can be also observed in other esophageal conditions. Structural abnormalities are believed to be found more often close to the lesser gastric curvature or the right esophageal wall. Furthermore, it could be shown with a standardized biopsy protocol that a good correlation with clinical findings is possible. Conventional histological criteria include thickness of basal cell layer, length of papillae and inflammatory infiltrates. New criteria include dilation of intercellular spaces and changes of protein distribution within intercellular spaces. All changes are reversible with PPI therapy. In conclusion, structural abnormalities are not specific for gastroesophageal reflux disease or NERD but are reversible with PPI, which underlines their relevance.

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Red Streaks in the Oesophagus in Patients with Reflux Disease: Is There a Histomorphological Correlate?

Cited by 38 publications

References 1 publication

Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

A pH-mucosa area unit of measure to consider morphology of the oesophagus when evaluating oesophagitis

Structural Abnormalities of Endoscopy-Negative Reflux Disease – Real or Perceived?

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