Lower Esophageal and Gastroesophageal Junction Mucin Histochemical Changes in Patients with Gastroesophageal Reflux Disease

A. AL-Dujaily, Esraa; H.Al-Mudhfer, Rehab; A. Kerbel, Hadeel; H. Al-Kelabi, Liwaa

	Lower Esophageal and Gastroesophageal Junction Mucin Histochemical Changes in Patients with Gastroesophageal Reflux Disease
Medical Journal of Babylon
Article 1, Volume 8, Issue 2, 2011, Pages 178-189
Authors
Esraa A. AL-Dujaily; Rehab H.Al-Mudhfer; Hadeel A. Kerbel; Liwaa H. Al-Kelabi
Abstract
Background: Gastro esophageal reflux disease (GERD) is a common entity worldwide including Iraq, where by 8% of normal population described typical symptoms of GERD. About 14% of patients with dyspepsia referred for upper GI endoscopy were found to have GERD. It is associated with complications including higher incidence of lower esophageal adenocarcinoma. Many studies have clearly demonstrated that this risk is directly related to the occurrence of IM in the lower esophagus so-called (Barrett esophagus) because of injurious effect of regurgitated acid peptic secretion over a long duration the squamous epithelium become replaced by columnar epithelium which is more resistant for acidic content of gastric juice and serve as a protection for the lower esophagus. Mucin histochemistry has been found a useful method to define type and distribution of glycoprotein in the GIT, and thus to define GERD patients at risk of neoplasia. Aims of the study: 1- To show the histopathological changes of lower esophagus and GEJ in patients with GERD. 2- To study the mucin histochemical changes in GEJ and lower esophagus and tackle the controversy concerning the nature and significance of mucin profile in this area. Patients and methods: The study was conducted on 30 patients suffering from symptoms suggestive of GERD as study group, with additional 10 patients taken as a control group who suffered from symptom other than GERD. Endoscopic biopsies were taken from GEJ and lower esophagus about 2 cm proximal to GEJ. The histopathological features of all cases were reviewed with emphasize on squamous epithelial changes (including intra epithelial eosinophiles , basal cell hyperplasia > 20% of mucosal thickness , papillary elongation > 70% of mucosal thickness) and metaplastic , dysplastic and carcinomatous changes. PAS diastase and combined alcian blue-aldehyde fuchsin stains were used to detect Mucin histochemical changes in the studied groups. Results: Our study revealed the presence of intra epithelial eosinophiles with basal cell hyperplasia > 20% of mucosal thickness were significantly associated with GERD in 70% of patients. By using special Mucin stains incomplete IM type IIB was found in 5 patients (16.7%) with GERD. Conclusions: Basal cell hyperplasia and intraepithelial eosinophiles are frequent histological findings in biopsies of patients with GERD. Mucin histochemistry is a useful method to define IM in esophageal and junctional biopsies. However the presence of IM type IIB does not correlate with the severity of endoscopic findings in GERD.
Keywords
GERF; Gastroesophageal reflux disease; intra epithelial eosinophiles; basal cell hyperplasia

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