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Does carditis have two different etiologies?
C Wolf1, C A Seldenrijk, R Timmer
1Department of Gastroenterology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Insights
Carditis etiology is controversial. This study found Helicobacter pylori (Hp) associated with carditis in normal SCJ patients, while gastroesophageal reflux linked to carditis in patients with irregular SCJ segments.
Area of Science:
- Gastroenterology
- Pathology
- Endoscopy
Background:
- Carditis etiology remains debated.
- Understanding carditis mechanisms is crucial for patient management.
Purpose of the Study:
- To investigate carditis prevalence and pathogenetic mechanisms.
- To differentiate etiological factors based on endoscopic and histological findings.
Main Methods:
- Biopsies from 664 patients analyzed histologically.
- Specimens stained for mucosa type, inflammation, metaplasia, and Helicobacter pylori (Hp).
- Correlation of findings with endoscopic appearance of the squamocolumnar junction (SCJ).
Main Results:
- Carditis prevalence was high (90.6% and 87.4%) in both patient groups.
- Hp infection strongly associated with carditis in normal SCJ.
- Gastroesophageal reflux features trended with carditis in irregular SCJ.
- Cardiac/mixed mucosa rare in the endoscopically defined cardia.
Conclusions:
- Two distinct etiologies for carditis suggested: Hp-associated in normal SCJ, and reflux-associated in irregular SCJ.
- Histological analysis of SCJ biopsies is key to understanding carditis.
- Findings highlight the importance of SCJ appearance in diagnosing carditis.
Abstract:
Carditis has become the subject of much study and discussion, although its etiology is still controversial. We wished to study the prevalence and possible pathogenetic mechanisms of carditis in a well-defined group of patients. In 664 patients biopsies were taken distal to the squamocolumnar junction (SCJ) and from the endoscopically defined cardia (2 cm below proximal margin of gastric folds). Specimens were stained with hematoxylin and eosin, Alcian blue, and modified Giemsa. Type of mucosa, inflammatory and metaplastic changes, and presence of Helicobacter pylori (Hp) were graded. Most of the patients had a normal appearing SCJ on endoscopy; 19.3% had short columnar segments (1-3 cm). In the first group cardiac/mixed mucosa was found in 71.9% of SCJ biopsies, and carditis (90.6%) was associated with Hp. In the second group, cardiac/mixed mucosa was present in 80.5%. There was a trend for an association between carditis (87.4%) and reflux esophagitis and hiatal hernia. Biopsies from the endoscopically defined cardia rarely contained cardiac/mixed mucosa (12.6%). These findings suggest two etiologies for carditis. In a normal-appearing SCJ carditis is associated with Hp, whereas in an irregular SCJ with short columnar segments/tongues carditis is associated with features of gastroesophageal reflux.