Gastroesophageal Reflux Disease (GERD)
Definition
- Changes in the gastroesophageal junction and distal esophagus secondary to reflux of gastric or duodenal contents into the esophagus
Diagnostic Criteria
- There is no gold standard for the diagnosis of GERD
- All three of the following are required for the diagnosis of GERD
- Elongated papillae
- >2/3 of the thickness of the mucosa
- Requires well oriented specimen
- Basal cell hyperplasia
- >15% of the thickness of the mucosa
- Requires well oriented specimen
- Intraepithelial granulocytes – at least one of the following is required
- Neutrophils – any are abnormal
- Eosinophils
- Any are abnormal
- ≥5/HPF raises the possibility of eosinophilic esophagitis
- If some but not all of these are present, the findings can be considered consistent with or suggestive of reflux
- Nonspecific findings
- Capillary dilation and extravasation
- Intraepithelial lymphocytes
- Ballooning degeneration of squamous cells
- Multinucleated squamous cells
- Mild chronic inflammation is nearly always present the gastroesophageal junction
- Identification of ulceration should prompt close evaluation and possibly stains for viruses, including Herpes and CMV
- Identification of neutrophils in the squamous mucosa should prompt a stain for fungi such as Candida
- Identification of neutrophils in the glandular mucosa should prompt close evaluation and stain for Helicobacter unless an accompanying gastric antral biopsy is available for assessment
- Identification of goblet cells may indicate Barrett esophagus
- Pancreatic metaplasia is seen frequently in biopsies from the EGJ
- It is not clear if this represents metaplasia or heterotopia
- No clinical significance
Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342
Original posting : November 11, 2009
