Histological characteristics of the lower esophagus among persons with and without GERD in a general population

The aim of the study was to describe the mucosal histology of the lower esophagus in a general population and study any differences in histological characteristics between people with (1) no gastroesophageal reflux disease (GERD), i.e., neither symptoms (GERS) nor esophagitis (reference group); (2) non-erosive reflux disease (NERD); (3) no GERS but endoscopic esophagitis; and (4) symptomatic esophagitis, i.e., both GERS and endoscopic esophagitis.

Randomly selected representatives from a general population were eligible for participation and participants (n = 384) underwent an upper gastroduodenoscopy and responded to the Abdominal Symptom Questionnaire. Multinomial logistic regressions were performed.

GERS in the last 3 months were reported by 28.4%, and 15.1% had esophagitis. At the Z-line, the median papillae length in the mucosa was 204.8 µm. It was higher in the asymptomatic esophagitis group (m = 262.6 µm), NERD group (m = 220.5 µm), and symptomatic esophagitis group (m = 217.1 µm), compared to the no GERD group (m = 197.4 µm). After adjusting for potential confounders, longer papillae lengths, higher basal layer thickness and total epithelial thickness just above the Z-line increased the likelihood of having symptomatic esophagitis, compared to having no GERD. Individuals with spongiosis 2-3 cm above the Z-line were more likely to have NERD rather than having no GERD (OR = 5.51, CI = 1.53-19.84).

This study presents the normal histology of the lower esophagus. There are subtle histological differences in the lower esophagus in people with and without GERS and esophagitis.