Intercellular space dilatations as histological markers in gastroesophageal reflux disease: a review.

Abstract

Despite its high prevalence in the general population, the diagnosis of Gastroesophageal Reflux Disease (GERD) remains a current challenge. The Montreal and Lyon consensus guidelines provide significant assistance in schematizing this problem; however, their recommendations and protocols cannot be applied in centers where the sophisticated methodology proposed does not exist, such as in Community Hospitals. For nearly six decades, the histological method has been used, with various approaches and success, as a useful procedure in the diagnosis of GERD. Nevertheless, although its description and methodology also date back to that time, the analysis and evaluation of Dilated Intercellular Spaces (DIS) as a histological marker of microscopic esophagitis has been scarcely considered. DIS appear wherever there is damage to the esophageal mucosa, generally caused by refluxed acid and/or alkali, regardless of whether endoscopic lesions are present or not. In this regard, they have been found in very high percentages in erosive GERD but also, with lower frequency, in non-erosive GERD, whether refractory to PPIs or not. The finding of DIS in Hypersensitive Esophagus (physiological pH-metry) is very surprising, and with much lower frequency, similar to that of controls, in Functional Heartburn. This could be explained by the high sensitivity of DIS, which appear even under conditions of minimal or physiological reflux. This review proposes the determination of DIS for the diagnosis of microscopic esophagitis.