Evaluation of the clinical characteristics of patients with grade A reflux esophagitis

Abstract

Objective To clarify the necessity of further examination in patients with grade Los Angeles classification (LA)-A reflux esophagitis diagnosed under endoscopy by evaluating the clinical and pathological characteristics. Methods From September 1st, 2011 to December 1st, 2012, patients with reflux esophagitis (LA-A, LA-B and LA-C) diagnosed under endoscopy were enrolled. All patients underwent gastroesophageal reflux disease questionnaire (GerdQ) score, endoscopy examination, tissue pathological examination, 24-hour esophageal pH monitoring and proton pump inhibitor (PPI) test. According to the results of 24-hour esophageal pH monitoring, the patients were regrouped. Group 1 was grade LA-A, the results of 24-hour esophageal pH monitoring indicating DeMeester score <14.7 and symptom index <50%; group 2 was grade LA-A, the results of 24-hour esophageal pH monitoring indicating DeMeester score ≥14.7 and symptom index≥50%; group 3 was grade LA-B and LA-C. Pathological examinations included proportion of basal cell layer in the epithelium layer, the proportion of elongation papillae in the epithelium layer, inflammatory cell number, congestion and bleeding of the papillae, vascular dilation in the papillae and dilated intercellular spaces (DIS) value. Mann-Whitney test or chi-square test was performed for statistical analysis. Results A total of 155 patients with reflux esophagitis were enrolled, among which 94 cases were LA-A, 49 were LA-B, and 12 were LA-C. There was no significant difference in the age, gender, body mass index (BMI), proportion of GerdQ score ≥8, proportion of symptom index≥50% and percentage of positive PPI test in LA-A group compared with LA-B group and LA-C group (all P>0.05). The median DeMeester score of grade LA-A group was 22.1, which was lower than that of grade LA-B group (32.1) and LA-C group (53.9), and the differences were statistically significant (Z=4.273, P=0.039; Z=7.210, P=0.007). Among 155 patients, the primary symptoms of 87 cases (56.1%) were heartburn and regurgitation; the secondary symptoms of 88 cases (56.8%) were heartburn and regurgitation. Between group 1 and group 2, there was no significant difference in the DIS, inflammatory cell number, proportion of basal cell layer in the epithelium layer and the proportion of elongation papillae in the epithelium layer (all P>0.05). The DIS value and the proportion of elongation papillae in the epithelium layer of group 3 were (1.229 9±0.393 0) μm and 59.1%, which were higher than those of group 1 ((0.973 9±0.317 3) μm and 52.1%), and the differences were statistically significant (t=-3.156, P=0.002; Z=-2.051, P=0.040). However, there was no statistically difference in inflammatory cells number and proportion of basal cell layer in the epithelium layer between two groups (both P>0.05). There was no statistically significant difference in the incident rates of papillae congestion and vascular dilation in the papillae among group 1, group 2 and group 3 (all P>0.05). The incidence of bleeding in the papillae of group 1 was 27.6% (8/29), which was lower than that of group 2 (49.2%, 32/65) and group 3 (50.8%, 31/61). And the differences were statistically significant (χ2=4.843, P=0.024; χ2=4.605, P=0.032). Conclusion Patients can be diagnosed as grade LA-A reflux esophagitis according to symptoms and the results of endoscopic examination, dispensing with further 24-hour esophageal pH monitoring and pathological examination. Key words: Esophagitis, peptic; Esophageal pH monitoring; Pathology; Los Angeles classification