SEVERITY OF BASAL CELL HYPERPLASIA DIFFERS IN REFLUX VERSUS EOSINOPHILIC ESOPHAGITIS

Abstract

Purpose: Basal cell hyperplasia of the esophageal epithelium is a frequent finding in children with endoscopic evidence of esophagitis. The aim of this study was to compare the severity of basal cell hyperplasia in reflux versus eosinophilic esophagitis. Methods: A cohort of patients who underwent same day endoscopy with esophageal biopsy and 24 hour esophageal pH monitoring was divided into groups based on endoscopic and pH monitoring findings. Basal cell hyperplasia was defined as normal (<25% of esophageal epithelial height), mild (26–50%), moderate (51–75%), or severe (>75%). Using chi-square analysis, the severity of basal cell hyperplasia in patients with abnormal pH monitoring studies (reflux index >6%), regardless of endoscopic findings, was compared with the severity in patients with eosinophilic esophagitis (≥20 eosinophils/hpf and normal pH monitoring). The severity of basal cell hyperplasia in patients with abnormal pH monitoring and endoscopic evidence of esophagitis was compared with the severity in patients with eosinophilic esophagitis. Results: Thirty-one children with abnormal pH monitoring were identified. Of these thirty-one children, fifteen had endoscopic findings consistent with reflux esophagitis. Thirty-two patients with eosinophilic esophagitis were identified. Patients with eosinophilic esophagitis had significantly more severe basal cell hyperplasia than patients with abnormal pH monitoring.Table: Severity of Basal Cell Hyperplasia in Patients with Abnormal pH Monitoring versus Patients with Eosinophilic EsophagitisPatients with eosinophilic esophagitis had significantly more severe basal cell hyperplasia than patients with abnormal pH monitoring and endoscopic evidence of esophagitisTable: Severity of Basal Cell Hyperplasia in Patients with Reflux Esophagitis versus Patients with Eosinophilic EsophagitisConclusions: Basal cell hyperplasia is more severe in children with eosinophilic esophagitis than in reflux esophagitis. Basal cell hyperplasia is likely stimulated by cytokines present in eosinophilic esophagitis. Prolonged stimulation of basal cells by these cytokines present in eosinophilic esophagitis may be responsible for stricture formation.