Endoscope versus microscope in the diagnosis of esophageal non-erosive reflux disease: a study of 71 cases

Background: Non-erosive reflux disease (NERD) is a type of gastroesophageal reflux disease (GERD) defined as symptomatic GERD without mucosal breaks on endoscopy. There is no gold standard for diagnosis of NERD till date. Biopsy from the distal esophagus in patients of GERD is said to reveal characteristic, although non-specific injury patterns such as squamous cell hyperplasia and intraepithelial inflammatory cell infiltration, collectively known as microscopic esophagitis. Recently, dilated intercellular spaces (DIS) are also shown to be associated with NERD. The present study was undertaken to evaluate the role of biopsy in NERD cases. Materials and methods: Two mucosal biopsies were taken at 3 cm above the squamocolumnar junction (SCJ) from 71 cases of NERD having symptom scores of more than 10. Biopsies were evaluated for features of microscopic esophagitis and DIS, and the results were analyzed. Results: Fifty out of 71 (70.4%) patients with symptomatic NERD had features of microscopic esophagitis. DIS was noted in 46/71 (64.8%) of cases, and correlated significantly with microscopic esophagitis (p