Clinicopathological Study Of Gastroeosophageal Reflux Disease

Abstract

The clinical diagnosis of GERD can be strongly suggested on the basis of the history and particularly the response to antacids or acid­ suppression therapy. As a result, most patients are not referred unless therapy is unsuccessful or when the diagnosis is unclear and GERD or other esophageal disease is being considered as a possibility for less conventional symptoms retrosternai --pain- -- -- ------

mimicking ischemic heart disease, or underlying respiratory disease,

• particularly asthma in children. By the tini.e referral occurs, many patients have already received H2-receptor antagonists (H2RA), such as cimetidine, ranitidine or famotidine, and proton pump inhibitors (PP!s), such as omeprazol, lansoprazol, or similar related drugs (Bytzer et at., 1993).

Endoscopy with biopsies can therefore be carried out on a spectrum of patients from those with severe clinical symptoms to those who have been treated successfully with PP!s and have been referred because they do not wish to continue taking them for life and are therefore considering some form of fundoplication, particularly if it can be carried out laparoscopically rather than at laparotomy or thoracotomy (Armstrong et

at., 1991).

GERD is difficult to define because of its extreme heterogeneity. Peptic lesions of squamous epithelium have a characteristic endoscopic appearance, but these lesions can occur transiently and may even be absent in severely symptomatic patients. Therefore, the endoscopic appearance has a high specificity but a low sensitivity for the diagnosis of GERD (Galmiche and Bruley des Varannes, 1994).