Abstract
Objective: To assess the relationship between histological findings in the cardia with histological findings of the oesohageal mucosa in patients with a symptomatology typical for gastroesophageal reflux disease. Patients and methods: The group comprised 271 patients examined on account of symptoms of gastroesopha- geal reflux disease.
All patients were examined endoscopically, incl. bioptic sampling from the antrum, cardia and terminal esophagus. The endoscopic picture was evaluated according to Savary-Miller´s classification.
The histological finding of reflux esophagitis was evaluated according to the author´s own classification: I. mild (reactive changes of the epithelium and slight inflammatory cellulization), II. medium (more intense inflam- matory cellulization), III. severe (intense inflammatory cellulization), IV. erosive, ulcerative (mucosal defect). Histological changes in the cardia were evaluated as acute gastritis, chronic gastritis and chronic active gastritis.The bioptic samples were also examined under the microscope for the presence of Helicobacter pylori.
Results: In the cardia histological examination revealed inflammatory changes (—carditisly) in 43.9% of the total number of 271 patients (acute gastritis in 1.8%, chronic gastritis in 25.5% and chronic active gastritis in 16.6%). A normal histological finding in the esophagus as well as in the cardia was found in 7.7% of 271 patients with reflux symptoms.On classification of histological findings into two classes (esophagitis, gastritis) a significant relationship was found between inflammations in the esophagus and cardia (p < 0.05).
Gastritis was recorded in 46.1% of 243 patients with a histologically confirmed reflux esophagitis and only in 25.0% of 28 patients with a normal histological finding in the esophagus.The incidence of carditis was significantly related to the presence of Helicobacter pylori. A more significant relation was found conversely between results of histological findings of inflammatory changes in the terminal esophagus and the presence of Helicobacter pylori in the gastric mucosa.
Conclusion: A significant relationship was found between histological findings in the esophageal and cardiac mucosa (p < 0.05). There were more patients with gastritis in the group with esophagitis than in the group with a normal finding in the esophagus.
Moreover the histological finding in the cardia was significantly associated with the presence of Helicobacter pylori (p < 0.001): in patients with inflammatory changes in the cardia Helicobacter pylori was detected more frequently than in patients with a normal histological finding in this area. No significant relationship was found between histological findings in the terminal esophagus and the presence of Helicobacter pylori in specimens of the gastric mucosa.