Diagnosis Of Esophagitis Research Articles

Reflux oesophagitis in children; the role of endoscopy: A multicentric Italian survey

Background The decision whether to perform endoscopy in children with suspected reflux oesophagitis is not a straightforward one. Few symptoms are specific for oesophagitis and the diagnosis is not always correlated even to visual findings on endoscopy. Aim The aim of this study was to define the role of endoscopy and especially of histology in the diagnosis of reflux oesophagitis and to examine the correlations between symptoms, endoscopic findings and histology in children with suspected gastroesophageal reflux disease. Patients and methods One hundred and thirty-six patients with a clinical diagnosis of reflux oesophagitis, aged 1–18 years (mean 8.43; standard deviation ±4.4), were enrolled from 12 Italian Paediatrics Gastroenterology Centres; symptom score, endoscopic and histologic oesophagitis scores were observed before and after therapy with proton pump inhibitors. Results Before therapy, a high correlation between the prevailing symptom score and endoscopic score was demonstrated, but not with histologic score: there was a significant tendency for histologic grade to exceed visual findings. After therapy, endoscopic score and histologic score were significantly improved. Conclusions Oesophageal biopsies increase the diagnostic accuracy of upper endoscopy. Histologic grading is often much more important than the endoscopic appearance, so that endoscopic oesophageal biopsies are very important aids in the diagnosis of oesophagitis. Appropriate clinical evaluation of symptoms must occur before endoscopic examination.

Bone Morphogenetic Protein 4 Expressed in Esophagitis Induces a Columnar Phenotype in Esophageal Squamous Cells

Barrett's esophagus (BE) is a metaplastic condition in which normal squamous esophageal epithelium is replaced by columnar epithelium. It is proposed that one of the possible mechanisms is dedifferentiation of squamous epithelium into columnar epithelium. The pathophysiology through which this metaplasia occurs is unknown. A recent study by serial analysis of gene expression showed that bone morphogenetic protein 4 (BMP-4) is uniquely expressed in BE. In this study, the role of the BMP pathway in the metaplastic transformation of normal squamous cells into columnar cells was examined. Tissues from patients with esophagitis and BE and in an esophagitis-BE rat model were examined for the activation of the BMP pathway. Short-term cultures of primary normal squamous esophageal cells were treated with BMP-4, and cell biological changes were examined by Western blot analysis, immunohistochemistry, and microarrays. In both human and rat tissues, the BMP pathway proved to be activated in esophagitis and BE. Upon incubation of squamous cell cultures with BMP-4, the cytokeratin expression pattern showed a shift that was consistent with columnar epithelium. Involvement of the BMP pathway was suggested by up-regulation of Phosphorylated-Smad 1/5/8 (P-Smad 1/5/8) that was effectively blocked by Noggin, a BMP antagonist. Comparison of the gene expression profiles of squamous cells, BMP-4-treated squamous cells, and BE cells showed a significant shift in the profile of the BMP-4-treated squamous cells toward that of the cultured BE cells. These results suggest that the BMP pathway could play a role in the transformation of normal esophageal squamous cells into columnar cells.

Esophagitis in Frail Elderly People

We studied the clinical course of elderly patients acutely hospitalized for various diseases, assessing any differences between patients with and without esophagitis. A case-control study on the presence of esophagitis was conducted on the clinical records of all in-patients undergoing gastroduodenoscopy at Padova Geriatric Hospital from 1997 to 2001. Data were examined on 338 sex-matched patients: 169 with a diagnosis of esophagitis and 169 with a negative endoscopy. Admissions for acute respiratory disorders [odds ratios (OR) 2.68; 95% confidence interval (CI) 0.89-8.01], a remote diagnosis of esophagitis (OR 11.34; 95%CI 2.68-48.07), obesity (OR 3.36; 95%CI 0.91-12.48), and being bedridden (OR 6.84; 95%CI 3.27-14.29) were found to be independent risk factors for the presence of esophagitis. The symptoms prompting the endoscopic diagnoses included: gastrointestinal bleeding (OR 7.61; 95%CI 2.76-21.0), heartburn (OR 4.58; 95%CI 1.86-11.28), and cough (OR 3.59; 95%CI 1.34-9.62). Steroids (OR 2.68; 95%CI 1.11-6.44) and calcium antagonists (OR 1.50; 95%CI 0.79-2.87) were associated with esophagitis as risk factors, whereas proton pump inhibitors (OR 0.46; 95%CI 0.25-0.87), nitrates (OR 0.14; 95%CI 0.02-0.78), and sucralfate in males (OR 0.09; 95%CI 0.01-0.92) were associated as protective factors. Patients with esophagitis were discharged with an endocrinologic/metabolic-type diagnosis. Deaths were significantly higher among patients with esophagitis (25 vs. 9); more severe esophagitis was characterized by a higher Charlson comorbidity index and a greater presence of anorexia and nausea. These findings seem to substantiate the theory that esophagitis is a characteristic which exacerbates frailty in hospitalized elderly people and its identification may be helpful in these patients.

Rapidly increasing prevalence of eosinophilic oesophagitis in Western Australia

Aim: To assess the prevalence of eosinophilic oesophagitis in a tertiary paediatric gastroenterology clinic population. Methods: A retrospective audit of Western Australian children investigated for oesophageal disease by paediatric gastroenterologists...

Eosinophil infiltration and degranulation in oesophageal mucosa from adult patients with eosinophilic oesophagitis: a retrospective and comparative study on pathological biopsy

Aim: To examine eosinophil infiltration and degranulation in 50 oesophageal biopsy specimens from 30 patients (21 men, 9 women; mean 39 years) with eosinophilic oesophagitis, by haematoxylin and eosin staining...

Does Endoscopic Appearance of Esophagus Always Suffice the Diagnosis of Esophagitis in Patients Presenting with Otolaryngologic Symptoms?

Does Endoscopic Appearance of Esophagus Always Suffice the Diagnosis of Esophagitis in Patients Presenting with Otolaryngologic Symptoms?

Does Endoscopic Appearance of Esophagus Always Suffice the Diagnosis of Esophagitis in Patients Presenting with Otolaryngologic Symptoms?

Does Endoscopic Appearance of Esophagus Always Suffice the Diagnosis of Esophagitis in Patients Presenting with Otolaryngologic Symptoms?

Diagnostic Value of Potent Acid Inhibition in Gastro-Oesophageal Reflux Disease

Gastro-oesophageal reflux disease (GORD) is defined as 'Chronic symptoms or mucosal damage produced by abnormal reflux of gastric contents into the esophagus'. The Genval Workshop Report defines that GORD exists when the frequency of heartburn is equal to or greater than 2 days/week and that it is one of the most common gastrointestinal conditions in the general population. Endoscopy is the most recommendable exploratory procedure in a patient with symptoms of GORD, fundamentally heartburn and regurgitation. However, 50-75% of the patients with symptoms compatible with GORD have normal endoscopy. Thus, endoscopy does not appear to be indispensable in a large group of patients with GORD. Endoscopy is therefore the gold standard for the diagnosis of reflux oesophagitis (histopathological changes in the oesophageal mucosa), but there is no gold standard for the diagnosis of non-erosive GORD. Twenty-four-hour pH monitoring has come to be considered the most sensitive and specific test in the diagnosis of GORD, but a significant proportion of patients (about 25%) have symptoms compatible with GORD and have 24-h pH monitoring results that can be considered normal. Besides, demonstrating the presence of acid reflux alone does not prove that it is the cause of suspected GORD-related signs or symptoms. Therefore, despite 'positive' pH studies, there is a significant number of patients failing to respond to therapy, mainly ear, nose and throat complaints, supposed as manifestations of gastro-oesophageal reflux disease. Despite 24-h oesophageal pH testing being an excellent diagnostic tool, it has no utility in routine clinical settings and hence its availability should be limited to tertiary care settings. With the demonstration that antisecretory treatment with high doses of proton pump inhibitors (PPIs) for 1 week or 2 weeks achieves significant improvement or even remission of the symptoms of GORD, it not surprising that it has been proposed as a diagnostic test for the disease. For patients with symptoms compatible with GORD without alarm symptoms or other suspected complications of GORD, a short course of empiric PPI therapy gives valuable information about the presence of GORD. The PPI test is a simple, sensitive and cost-effective tool, but it has insufficient specificity for use as an objective criterion alone. The use of PPIs both as a diagnostic test (1-2 weeks) and as a diagnostic-therapeutic test (1-4 months) has a moderate usefulness and may be used especially in those environments in which there are difficulties in performing the objective test.

P1046 ENDOSCOPIC MANIFESTATIONS OF EROSIVE ESOPHAGITIS IN CHILDREN

Introduction: The manifestations of gastroesophageal reflux disease (GERD) can be limited to symptoms (e.g., heartburn, regurgitation) or can be more complicated, such as erosive esophagitis (EE), esophageal strictures or Barrett’s esophagus. EGD is performed to evaluate and a diagnosis is often made without mucosal biopsy. PURPOSE: To compare the accuracy of the endoscopic impression of EE vs. the esophageal histology. Methods: All children aged 0 to 18 years who underwent EGD that was recorded in the Pediatric Endoscopic Database System - Clinical Outcomes Research Initiative (PEDS-CORI) at Texas Children’s Hospital (TCH) between 1999 and 2002 were included. Endoscopic reports that were incomplete, missing demographic features, indications for endoscopy or endoscopic findings were excluded. The endoscopic impression of EE was defined either descriptively (e.g. erythema, erosion) or by Los Angeles classification. Reflux esophagitis was defined as having basal cell hyperplasia, elongation of the rete pegs and presence of an eosinophillic infiltrate. The TCH pathologist made the final diagnosis of esophagitis. Each endoscopic descriptor was compared to the results of the esophageal biopsy, and Chi Square analysis performed. Results: 2894 children who underwent EGD at TCH fulfilled the inclusion criteria. 362 (12.5%) had EE by endoscopic criteria. Esophageal biopsies were available on all 362 children. 226 / 362 (62.4%) had esophagitis on histology. Of these 226 children, esophageal inflammation was the most common finding in 106/226 (47%), followed by erosion 26/226 (11.5%), ulcer 24/226 (10%), erythema 23/226 (10%), hyperemia 19/226 (9%), nodularity 9/226 (4%) and 19/226 (9%) listed other. The endoscopic finding of erosion predicted esophagitis in 23/26 (88%)(p=0.01), ulcer in 20/24 (83%)(p=0.01), nodularity in 7/9 (78%)(p=0.01), hyperemia in 14/19 (74%)(p=0.05), erythema in 11/23(52%) (p>0.05 NS) and esophageal inflammation in 53/106 (50%)(p>0.05, NS). Conclusion: Specific findings such as ulcer, erosion, nodularity and hyperemia were accurate predictors of histologic esophagitis, whereas subjective manifestations such as color (e.g., erythema) and esophageal inflammation were not. These results suggest that visible alterations in mucosal architecture rather than color improve endoscopic diagnosis.

Gastro-oesophageal reflux disease, reflux oesophagitis and non-erosive reflux disease in a multiracial Asian population: a prospective, endoscopy based study.

To determine the prevalence of and risk factors for gastro-oesophageal reflux disease (GORD), reflux oesophagitis and non-erosive reflux disease (NERD) amongst Malaysian patients undergoing upper gastrointestinal endoscopic examination. A cross-sectional study on consecutive patients with dyspepsia undergoing upper gastrointestinal endoscopy. A large general hospital in Kuala Lumpur, Malaysia. Consecutive patients undergoing endoscopy for upper abdominal discomfort were examined for the presence of reflux oesophagitis, hiatus hernia and Barrett's oesophagus. The diagnosis and classification of reflux oesophagitis was based on the Los Angeles classification. Patients with predominant symptoms of heartburn or acid regurgitation of at least one per month for the past 6 months in the absence of reflux oesophagitis were diagnosed as having NERD. The prevalence of GORD, reflux oesophagitis and NERD were analysed in relation to age, gender, race, body mass index (BMI), presence of hiatus hernia, Helicobacter pylori status, alcohol intake, smoking and level of education. One thousand patients were studied prospectively. Three hundred and eighty-eight patients (38.8%) were diagnosed as having GORD based on either predominant symptoms of heartburn and acid regurgitation and/or findings of reflux oesophagitis. One hundred and thirty-four patients (13.4%) had endoscopic evidence of reflux oesophagitis. Two hundred and fifty-four (65.5%) were diagnosed as having NERD. Hiatus hernia was found in 6.7% and Barrett's oesophagus in 2% of patients. Of our patients with reflux oesophagitis 20.1% had grade C and D oesophagitis. No patients had strictures. Following logistic regression analysis, the independent risk factors for GORD were Indian race (odds ratio (OR), 3.25; 95% confidence interval (CI), 2.38-4.45), Malay race (OR, 1.67; 95% CI, 1.16-2.38), BMI > 25 (OR, 1.41; 95% CI, 1.04-1.92), presence of hiatus hernia (OR, 4.21; 95% CI, 2.41-7.36), alcohol consumption (OR, 2.42; 95% CI, 1.11-5.23) and high education level (OR, 1.52; 95% CI, 1.02-2.26). For reflux oesophagitis independent the risk factors male gender (OR, 1.64; 95% CI, 1.08-2.49), Indian race (OR, 3.25; 95% CI, 2.05-5.17), presence of hiatus hernia (OR, 11.67; 95% CI, 6.40-21.26) and alcohol consumption (OR, 3.22; 95% CI, 1.26-8.22). For NERD the independent risk factors were Indian race (OR, 3.45; 95% CI, 2.42-4.92), Malay race (OR, 1.80; 95% CI, 1.20-2.69), BMI > 25 (OR, 1.47; 95% CI, 1.04, 2.06) and high education level (OR, 1.66; 95% CI, 1.06-2.59). Reflux oesophagitis and Barrett's oesophagus were not as uncommon as previously thought in a multiracial Asian population and a significant proportion of our patients had severe grades of reflux oesophagitis. NERD, however, still constituted the larger proportion of patients with GORD. Indian race was consistently a significant independent risk factor for reflux oesophagitis, NERD and for GORD overall.

Twenty Year Follow-Up of Reflux Oesophagitis: Long Term Consequences and Complications

Introduction: Reflux oesophagitis is the most common abnormal finding at OGD yet the long term outcome of the condition is unknown. This study assessed the level of reflux symptoms, drug consumption and complications in patients 20 years after diagnosis of oesophagitis.

Endoscopic Manifestations of Erosive Esophagitis in Children

The manifestations of gastroesophageal reflux disease (GERD) can be limited to symptoms (e.g. heartburn, regurgitation) or can be more complicated, such as erosive esophagitis (EE), esophageal strictures or Barrett's esophagus. EGD is commonly performed to evaluate GERD symptoms and an endoscopic diagnosis, such as EE, is often made without mucosal biopsy. PURPOSE: To compare the diagnostic accuracy of the endoscopic impression of EE vs. the esophageal histology. METHODS: All children aged 0 to 18 years who underwent EGD that was recorded in the Pediatric Endoscopic Database System - Clinical Outcomes Research Initiative (PEDS-CORI) at Texas Children's Hospital (TCH) between 1999 and 2002 were included. Endoscopic reports that were incomplete, missing demographic features, indications for endoscopy or endoscopic findings were excluded. The endoscopic impression of EE was defined either descriptively (e.g. erythema, hyperemia, inflammation, erosion, ulcer and nodule) or by Los Angeles classification. Reflux esophagitis was defined as histologic evidence of basal cell hyperplasia, elongation of the rete pegs and presence of an eosinophillic infiltrate. The TCH pathologist made the final diagnosis of esophagitis. Each endoscopic descriptor was compared to the results of the esophageal biopsy, and Chi Square analysis was performed. RESULTS: 2894 children who underwent EGD at TCH fulfilled the inclusion criteria. 362 (12.5%) had EE by endoscopic criteria. Esophageal biopsies were available on all 362 children. 226 / 362 (62.4%) had esophagitis on histology. Of these 226 children, the endoscopic finding of esophageal inflammation was the most common 106/226 (47%), followed by erosion 26/226 (11.5%), ulcer 24/226 (10%), erythema 23/226 (10%), hyperemia 19/226 (9%), nodularity 9/226 (4%) and 19/226 (9%) listed other. The endoscopic finding of erosion predicted esophagitis in 23/26 (88%)(p=0.01), ulcer in 20/24 (83%)(p=0.01), nodularity in 7/9 (78%)(p=0.01), hyperemia in 14/19 (74%)(p=0.05), erythema in 13/23 (57%)(p<0.05, Not Significant), esophageal inflammation in 53/106 (50%)(p<0.05, Not Significant). CONCLUSIONS: Specific endoscopic findings such as erosion, ulcer, nodularity and hyperemia were accurate predictors of histologic esophagitis, whereas more subjective manifestations such as color (e.g., erythema) and esophageal inflammation were not. These results suggest that visible alterations in mucosal architecture rather than color improve endoscopic diagnosis.

Les gastrinomes dans les néoplasies endocriniennes multiples de type 1. Une étude de cohorte de 127 cas du groupe des tumeurs endocrines (GTE)

On July 2000, 127 gastrinomas (31.1%) were studied by the Endocrine Tumour Group (GTE) using a 408-patient cohort of Multiple Endocrine Neoplasia Type 1 patients. The aim of this study was to assess clinical, biological, surgical data as well as their trends over three periods (<1980–1980/1989–>1990). A Zollinger–Ellison syndrome (SZE) was present in 96% of the cases. Mean age at the onset of the disease was 39.4 years. There were 55.9% of men. Synchronous liver metastasis was present in 7.1%. Taken independently, the positivity of the four main diagnosis tests decreased over the time. The diagnosis of oesophagitis increased (4.5–29.7%), as well as the size of the resected tumours (9.9–16.8 mm). There was an increase in the familial background diagnosis (73.1–80%), an increasing use of Octreoscan scintigraphy and transduodenal ultrasound with positive detection of metastasis and tumours in 81.3% and 92.3%, respectively after 1991. Patients were operated on less frequently (96–52.5%), less frequently from the pancreas (87.5–37.5%), and from the gastro-intestinal tract (70.8–30%). The relative percentage of major pancreatic resections increased (with at least removal of the duodenum and the pancreatic head) (10–26.7%). The operative mortality disappeared. Six out of the seven patients (85.7%) who benefited from major pancreatic resections normalized their gastrine level postoperatively versus 15% in less radical techniques. Overall 5 years survival was 90 ± 4.4%. Survival increased after 1985 (85 ± 4.8% versus 95 ± 3.6, P = 0.1). Conclusion. – SZE in NEM1 were diagnosed at an earlier stage and were less frequently operated on. Nevertheless, the incidence of synchronous metastasis did not change significantly. Patients were mainly operated on for gastric emergencies and pancreatic tumours in order to prevent metastasis without mortality after 1991.

Histological score for cells with irregular nuclear contours for the diagnosis of reflux esophagitis in children

Histological criteria for the diagnosis of reflux esophagitis include basal zone hyperplasia, stromal papillae elongation, and inflammatory infiltrate. However, endoscopic esophageal biopsy specimens may include little or no lamina propria. Intraepithelial T lymphocytes, seen in hematoxylin and eosin-stained sections as cells with irregular nuclear contours (CINC), may have a higher density in children with esophagitis. We evaluated the diagnostic accuracy of a numerical score built up by grading the “classical” parameters and its correlation with CINC density in grasp biopsy specimens obtained from children undergoing esophagogastroduodenoscopy with and without esophagitis. We analyzed esophageal biopsy specimens from 349 children (median age, 5 years) subdivided in 4 groups according to the previous routine histology report: group 1, 144 children with esophagitis; group 2, 65 controls; group 3, 51 children with dubious esophagitis; and group 4, 75 children with esophagitis on endoscopy but a normal histology report. A numerical value was assigned to each parameter; the sum of these values represented the histological score. We also evaluated intraepithelial CINC density (ie, number of CINC per high-power field). We separately analyzed histological sections with and without lamina propria. For both total score and for CINC density, we calculated a cutoff using a receiver operating characteristic curve. Cutoffs of 6 for score and of 4 for CINC density provided the best sensitivity and specificity. Sensitivity of the histological score was better in biopsy specimens containing lamina propria (94%) than in those without lamina propria (4%). Sensitivity of CINC density was satisfactory in both specimens with (78%) and without (75%) lamina propria. Specificity was satisfactory for both parameters. In conclusion, when lamina propria was present in sections of endoscopic esophageal biopsy specimens, histological score provided a better diagnostic accuracy for the diagnosis of esophagitis. However, when no lamina propria was present, as was the case in 67% of our children, CINC density had better sensitivity. In addition, this latter parameter showed esophageal mucosa damage in 34% of previously dubious cases or cases with esophagitis at endoscopy but a previous routine histology report of normal mucosa.

Predictive factors of the long‐term outcome in reflux esophagitis in a low‐prevalence gastroesophageal reflux disease region

Background: There are no data concerning the long‐term outcome of patients with reflux esophagitis in Taiwan. In this study the outcome and the specific prognostic indicators associated with outcome in patients were assessed retrospectively, 7 years after diagnosis of esophagitis. Methods: The study comprised a total of 128 patients with endoscopic esophagitis, diagnosed between January and June 1995, at Taichung Veterans' General Hospital. The outcome at 7 years after diagnosis was assessed by outpatient or telephone interview. Factors associated with requiring long‐term acid suppression therapy were analyzed. Results: In all, 105 patients were eligible for analysis; 61 patients (58.1%) with LA (Los Angeles classification) grade A, 29 patients (27.6%) with grade B, 11 patients (10.5%) with grade C and 4 patients (3.5%) with grade D esophagitis. Seven years after diagnosis, there were 52 patients (49.5%) with no or occasional reflux symptoms, 8 patients (7.6%) with occasional symptoms requiring treatment with histamine‐2 receptor antagonists (H2RAs), 12 patients (11.4%) with occasional symptoms requiring treatment with proton pump inhibitors (PPIs), as needed, and 33 patients (31.3%) with sustained symptoms needing daily maintenance with PPIs. Conclusion: Nearly 50% of patients in Taiwan with endoscopic esophagitis still required treatment 7 years after diagnosis. Approximately 31% of patients still required daily acid suppression therapy. Presence of hiatal hernia and the severity of esophagitis at initial endoscopy independently were predictive of those who would require long‐term acid suppression therapy.

Corpus gastritis in patients with endoscopic diagnosis of reflux oesophagitis and Barrett's oesophagus.

A high level of gastric acid secretion is considered to be a risk factor for reflux oesophagitis or Barrett's oesophagus. Corpus gastritis may have a protective effect on the oesophagus, because of decreased gastric acid output. To determine if corpus gastritis is associated with reflux oesophagitis or Barrett's oesophagus. Three antral and two corpus biopsies were taken from consecutive patients in whom Helicobacter pylori testing was requested during endoscopy at a single centre between January 1995 and May 1997. Antral and corpus gastritis was studied by histology; H. pylori was studied by histology, culture and CLO test. A regression model was used to test for correlation between reflux oesophagitis, Barrett's oesophagus and risk factors. During the study period, 676 patients had biopsies taken during upper gastrointestinal endoscopy. Endoscopic signs of reflux oesophagitis and Barrett's oesophagus were observed in 125 and 23 patients, respectively. Corpus gastritis was found in 59% of patients without reflux oesophagitis or Barrett's oesophagus, 45% of patients with reflux oesophagitis and 30% of patients with Barrett's oesophagus. Two hundred and fifty-seven patients underwent follow-up endoscopy after H. pylori therapy. During a mean follow-up of 3 months, the incidence of reflux oesophagitis was not statistically different for patients with healing of corpus gastritis (10/98; 10%) and patients with persistent gastritis (8/97; 8%). Corpus gastritis was less common in patients with an endoscopic diagnosis of reflux oesophagitis or Barrett's oesophagus.

Bile reflux gastritis and Barrett's oesophagus: further evidence of a role for duodenogastro-oesophageal reflux?

BACKGROUNDThere is increasing evidence that reflux of bile plays a part in the pathogenesis of Barrett's oesophagus. Bile injury to the gastric mucosa results in a “chemical” gastritis in which...

Characterization of the inflammatory infiltrate in peptic oesophagitis.

The diagnosis of oesophagitis is mainly based on histology, but interpretation of endoscopic biopsies is often difficult. We performed immunohistochemical studies on oesophageal biopsies to see if better characterization of the inflammatory cell infiltrate would improve the accuracy of the histologic diagnosis of gastro-oesophageal reflux disease. The study groups consisted of 40 consecutive children (mean age +/- SD: 79.6 +/- 5l.9 months; 20 boys) with gastro-oesophageal reflux disease and 7 symptomatic children (mean age +/- SD: 52.6 +/- 37.0 months; 3 boys) without gastro-oesophageal reflux disease. All patients underwent upper gastrointestinal endoscopy with oesophageal biopsies. The diagnosis of gastro-oesophageal reflux disease was established by conventional endoscopic and histologic criteria. In each mucosal biopsy specimen, the number of intraepithelial CD3+, CD25+ (IL2 receptor+), ICAM+, HLA-DR+ and mucosal mast cells were determined. Conventional histology was in close agreement with endoscopic findings (p<0.001) and reflected the clinical score even more than endoscopic findings. Conventional histology significantly correlated with each inflammatory immunohistochemical marker (<0.05 for each), but the markers were not predictive of symptom severity. Immunohistochemical markers were always abnormal in the gastro-oesophageal reflux disease patients, even in the mildest cases of oesophagitis. Although there is a good correlation between symptoms and histology, in a subset of patients, immunohistochemical studies appear useful in supporting the histological diagnosis of gastro-oesophageal reflux disease.

The prescribing of acid suppressants prior to the endoscopic diagnosis of Barrett's oesophagus and oesophagitis.

There has been a dramatic rise in incidences of Barrett's oesophagus and oesophageal adenocarcinoma. It has been suggested that the introduction and use of acid suppression therapy may be a factor in the rising incidences of Barrett's oesophagus and oesophageal adenocarcinoma. This was a record linkage study, using a prescribing database and an endoscopy database. Patients who had undergone their first endoscopy during the period 1992-1995 and received the diagnosis of Barrett's oesophagus or oesophagitis were identified. The prescribing of acid suppressants was compared for the 3 years prior to endoscopy, between those with Barrett's oesophagus and those with oesophagitis. There was no significant difference between the Barrett's patients and the oesophagitis patients in the proportion that had been exposed to acid suppression therapy (53.4% vs. 51.7%, P=0.704). The mean number of days of prescribing among those who had been exposed to acid suppression therapy was higher in the Barrett's group (340.5 vs. 237.0 days, P=0.001). Patients with Barrett's oesophagus have received more acid suppressant therapy prior to diagnosis. The reasons for this are not clear. However, 46.6% of Barrett's patients have not been exposed to acid suppressant therapy.

Relationship of iron-deficiency anemia with esophagitis and hiatal hernia: hospital findings from a prospective, population-based study.

Iron-deficiency anemia is sometimes attributed to esophagitis and hiatal hernia; however, because these GI conditions are so common, such an association could be coincidental. We examined prospectively whether esophagitis and hiatal hernia increased the risk of iron-deficiency anemia in a national, population-based study. The study population comprised 5069 adult participants in the first National Health and Nutrition Examination Survey, who were free of GI hemorrhage and anemia at baseline examination in 1971-1975 and who were hospitalized at some point during nearly 20 yr of follow-up. Rates of hospitalization with iron-deficiency or unspecified anemia were compared between patients with a hospital diagnosis of esophagitis or hiatal hernia and those who had not yet had a diagnosis of these disorders. Adjusted rate ratios were calculated using time-dependent, multivariable, proportional hazards analysis. During follow-up, 59 patients were hospitalized with esophagitis alone, 140 with hiatal hernia alone, and 70 with both diagnoses. A total of 102 participants were hospitalized with iron-deficiency anemia and 256 with unspecified anemia. Compared to those without a diagnosis of esophagitis or hiatal hernia, patients with a diagnosis of hiatal hernia had higher rates of subsequent hospitalization with iron-deficiency anemia. The hazard rate ratio (HRR) for hiatal hernia was 2.9 (95% confidence interval, 1.5-5.5). A trend was found for esophagitis with a HRR of 2.2 (95% confidence interval, 0.79-6.0). Results were similar with unspecified anemia as the outcome. Hiatal hernia should be considered as a possible cause of iron-deficiency anemia. The relationship of esophagitis with iron-deficiency anemia requires further study.