Original article
Inflammation of the gastric cardia in children with symptoms of acid peptic disease

https://doi.org/10.1067/S0022-3476(03)00392-5Get rights and content

Abstract

Objectives

To assess the severity and causes of inflammation of the gastric cardia in children undergoing endoscopy for symptoms of acid peptic disease.

Study design

Patients undergoing upper gastrointestinal endoscopy for symptoms of acid peptic disease had biopsies from gastric cardia, gastric, and esophageal sites, and 24-hour intraesophageal pH monitoring. Gastric cardia was defined at endoscopy as the anatomic zone from the squamocolumnar junction to 0.5 cm below it. Severity of gastric cardia inflammation was scored 0 to 9 according to densities of inflammatory cells and epithelial abnormalities in surface and pit epithelium. A score ≥2 was considered positive.

Results

Forty-seven children (median age, 6.5 years; range, 3–15) had Helicobacter pylori infection, gastroesophageal reflux disease (GERD), or both. In 22 patients, H pylori was detected in cardiac biopsies by rapid urease test and histology; it was detected also in the corpus and antrum in only seven of the 22. No patient had H pylori in gastric corpus/antrum without having the organism at the cardia as well. In 12 H pylori-positive patients, GERD was also diagnosed. Twenty-five patients had GERD and no H. pylori infection. Severity score was 3.8±0.8 in the H pylori group and 2.08±0.9 in the GERD alone group (P<.001); however, there was no difference in reflux index (24-hour % of gastroesophageal reflux) between the two groups. In neither group was correlation found between reflux index and severity score (H pylori, r = 0.22; GERD alone, r = 0.31; NS) nor between cardia inflammation and esophagitis grade (H pylori, r = 0.37; GERD alone, r = 0.22; NS).

Conclusions

In children with symptoms of acid peptic disease, inflammation of the gastric cardia does occur. It is more severe when the cardiac zone is infected with H pylori than in its absence. Of major practical significance is the finding that the gastric cardia is a highly sensitive site for the detection of H pylori infection.

Section snippets

Patients and methods

The study group was composed of children undergoing upper gastrointestinal endoscopy for suspected acid peptic disease between July and December 2000. Selected were children who had a diagnosis of H pylori, GERD, or both. Exclusion criteria were previous H pylori eradication, known infectious and systemic disorders, gastrointestinal surgery, structural abnormalities of the gastrointestinal tract, major neurological impairment (eg, cerebral palsy), previous esophageal surgery, hiatal hernia, and

Results

During the 7-month period of patient acquisition, the total number of diagnostic endoscopies performed for all indications was 89. Of these, 47 patients had H pylori infection, GERD, or both; diagnoses in the other 42 patients included celiac disease and food allergy. Some patients with reflux disease or H pylori infection were excluded from the study because of failure to consent or sedation inadequate to take biopsies from all sites. From the 47 patients, a total of 144 endoscopic biopsies

Discussion

We describe the histological features of the gastric cardia in pediatric patients investigated for symptoms and signs of acid peptic disease. Like other forms of gastritis,22 inflammation of the gastric cardia is a histologic, not an endoscopic, diagnosis. It is a commonly detected finding in endoscopic biopsies of adults investigated for dyspepsia or acid-related disease. However, study results in adults are divided about whether the inflammation of the gastric cardia is part of a diffuse or

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