DEMEESTER SCORE AND HISTOPATHOLOGIC FINDINGS ON LOWER ESOPHAGEAL BIOPSY: DO THEY CORRELATE?
Elizabeth Bruenderman*, Matthew Woeste, Joseph T. Miller, Stacy Block, Robert C. Martin, Farid Kehdy
Department of Surgery, University of Louisville, Louisville, KY
Background: A DeMeester score greater than 14.7 is a widely accepted method of diagnosing acid reflux. Esophageal acid exposure is thought to cause erosive esophagitis and glandular metaplasia (Barrett's esophagus) in the lower esophagus, with potential progression to dysplasia and adenocarcinoma. However, a correlation between an elevated DeMeester score and histopathologic progession to metaplasia and dysplasia is not well-established. This study aimed to evaluate the correlation between the DeMeester score and its components with histopathologic findings on lower esophageal biopsies.
Methods: Patients in a single center who underwent esophagogastroduodenoscopy (EGD) with biopsy of the lower esophagus, as well as 24- to 48-hour pH monitoring, were evaluated. Patients were grouped according to biopsy findings: normal squamous epithelium, squamous epithelium with inflammation, or glandular epithelium. Mean Demeester scores and the mean of DeMeester score components were compared between groups.
Results: Eighty patients were evaluated: 17 (21.3%) with normal squamous epithelium, 59 (73.7%) with inflammatory squamous epithelium, and 4 (5.0%) with glandular epithelium. There was no difference between age, gender, BMI, or presence of hiatal hernia between the groups. The mean DeMeester score did not differ between the groups (29.9 normal, 29.4 inflammatory, 42.3 glandular; p=0.62). The mean of DeMeester score components did not differ between the groups: total number of reflux episodes (88.3 normal, 113.1 inflammatory, 108.8 glandular, p=0.52), total number of reflux episodes > 5 minutes (6.4 normal, 7.8 inflammatory, 12.0 glandular; p=0.42), longest reflux episode (26.7 normal, 27.8 inflammatory, 56.0 glandular; p=0.16), % total time (minutes) pH < 4 (6.8 normal, 8.1 inflammatory, 11.9 glandular; p=0.41), % upright time pH < 4 (7.5 normal, 9.3 inflammatory, 13.1 glandular; p=0.41), and % supine time pH < 4 (4.7 normal, 5.6 inflammatory, 9.6 glandular; p=0.56).
Conclusions: The DeMeester score and its components did not show a correlation with histopathologic findings on esophageal biopsy. Though the DeMeester score is an index measuring the severity of acid reflux, the findings of this study suggest reflux-induced histopathologic changes are correlated with factors not accounted for in the DeMeester scoring system. The DeMeester score should be used only to distinguish reflux symptoms as secondary to acid exposure, and should not prompt biopsy of the lower esophagus in the absence of visual signs of Barrett's esophagus.
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