الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Introduction: Gastroesophageal reflux disease (GERD) is a chronic, relapsing acid-peptic disorder characterized by recurrent troublesome reflux symptoms; esophageal injury, such as reflux esophagitis; a variety of extra esophageal complications, reduced salivary production, and altered esophageal mucosal resistance The diagnosis of GERD is based on the combination of clinical symptoms, endoscopic findings, pH monitoring, and histologic changes. However, GERD is a heterogeneous disease, and the findings in these tests do not always correspond. Thus,a multidisciplinary approach for diagnosis is increasingly required. Aim of the work: This study was specifically designed to determine the correlation between the clinical, endoscopic and histological findings in patients with the typical symptoms of GERD. Patients and Methods: 68 patients (36 males & 32 females) complaining of typical GERD symptoms for at least 12 weeks, not necessarily consecutive, during the previous 12 months were enrolled in this study. They underwent upper GI endoscopy and Los Angeles classification was used for grading cases with mucosal breaks and biopsies were taken from esophago-gastric junction. 24 hour PH monitoring and esophageal manometry were also performed for each patient. Correlation/regression analysis was done on clinical, endoscopic and histological findings. Fifteen apparently healthy subjects (9 males and 6 females) not complaining of any GERD symptoms were recruited as controls. Results: Biopsies were assessed for basal cell hyperplasia, papillae elongation, intercellular space dilatation, intraepithelial eosinophils infiltration, intraepithelial neutrophil infiltration and erosions. A global severity score was calculated on the basis of the above parameters and allowed the distinction of patients from controls with 82.4% sensitivity and 86.7% specificity. There global severity score was directly correlated to the frequency of reflux episodes. It was also directly related to the time elapsed below pH 4.0 and the composite pH score. Conclusion: In contrast with previous reports on the marginal role of histology in patients with GERD, our study shows that this technique can be a useful diagnostic tool, particularly in patients with NERD where it may contribute to diagnosis and play a role in the comparative evaluation of different therapies.