618 ESOPHAGEAL HISTOLOGY IN PEDIATRIC PATIENTS: MEASURES OF ESOPHAGITIS AND CORRELATION WITH GASTROESOPHAGEAL REFLUX (GER)

Abstract

Suction biopsies (BXs) containing full thickness epithelium (EPI) and muscularis mucosae (MUS) were obtained from 56 patients (mean age 15.2 mos; 34 male, 22 female) referred for evaluation of symptoms of GER and/or esophagitis and were stained with H&E and Luna (for eosinophils). Autopsy material from motor accident victims (n=5, mean age 10.6 mos) was used as control tissue. Morphometric studies included % basal cell thickness (BCT,nl <20), % papillary height (PAP,nl<60), EPI eosinophils/mm MUS (EOS,nl-absent), and neutrophils/mm MUS (PMN,nl-absent). Esophagitis was diagnosed when any value was abnormal. Continuous 24 hr esophageal pH monitoring was done in 39 patients.Esophagitis was found in 45 BXs. Of 32 patients who had abnormal GER, 27 had esophagitis and 5 did not; of 7 without GER, 5 had esophagitis and 2 did not. EOS were seen in only 10 BXs, and 9 of those had other criteria for esophagitis. PMN were seen in only 4 BXs; 3 had other criteria for esophagitis.CONCLUSIONS: Our data indicate accepted adult values for esophagitis apply to children. Most symptomatic patients have both GER and esophagitis, but GER does not always predict esophagitis. Historically, EOS and PMN, which can be found in pinch BXs, are insensitive but specific indicators of esophagitis. Suction BX improves sensitivity because all histologic elements are present.