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Gastroesophageal Reflux Disease (GERD)

Fast factoids about GERD:

  • GERD is a common cause of inflammation of the distal esophagus epithelium

  • Caused by reflux of the acidic gastric contents into the tubular esophagus

  • GERD is important to recognize owing to its association with strictures, Barrett mucosa, and malignancy.

  • At this time there are no official consensus recommendations on biopsy protocol for GERD uncomplicated by Barrett esophagus or eosinophilic esophagitis (EoE).

  • Treatment typically includes lifestyle modification and proton-pump inhibitors, with surgical procedures reserved for severe, refractory cases.


Key Features of GERD:

  • **Dilatation of intercellular spaces

  • **Elongation of the vascular papillae

  • Basal hyperplasia

  • Intraepithelial eosinophils

  • Vascular lakes

  • Increased intraepithelial T lymphocytes

  • Balloon cells (large squamous epithelial cells with abundant pale pink, smudgy cytoplasm)

(some, not all, are required)


Signing out GERD

GERD can further be stratified into three categories to more accurately describe the degree of pathology:

  • Mild (subtle findings, including rare intraepithelial eosinophils)

  • Moderate (conspicuous findings)

  • Marked GERD (striking findings)

Examples of each can be seen below.


Marked GERD vs. Eosinophilic Esophagitis (EoE)It is clinically important to distinguish EoE from GERD because of differing etiologic specific therapies. Features favoring EoE include:

  • Superficial eosinophilic microabscesses

  • Eosinophil counts greater than 50/HPF

  • Basal hyperplasia greater than 50%.

Since an unmapped biopsy of EoE can be histologically indistinguishable from GERD, clinicopathologic correlation and mapping of tandem proximal and distal esophageal biopsies are necessary to more definitively distinguish EoE from GERD.

See separate post on Eosinophilic esophagitis for more information (COMING SOON)


Continue reading to learn more about GERD and how it can lead to intestinal metaplasia, dysplasia and eventually cancer! Click here to see post.


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