Carditis at the interface between GERD and Helicobacter pylori infection

Area of Science:

• Gastroenterology
• Histopathology

Background:

• Carditis is inflammation of the gastric cardia, a histological diagnosis.
• Its causes, primarily Helicobacter pylori infection and gastroesophageal reflux disease (GERD), and their interactions are debated.
• The clinical significance of carditis regarding symptoms and cancer risk is unclear due to anatomical variations and conflicting study data.

Purpose of the Study:

• To evaluate the histological criteria for carditis, potentially adapting the updated Sydney classification.
• To investigate the controversial roles of H. pylori and GERD in carditis development and inflammation.
• To clarify the clinical relevance and cancer risk associated with carditis.

Main Methods:

• Review and adaptation of histological criteria from the updated Sydney classification for the gastric cardia.
• Analysis of existing literature on H. pylori infection and GERD in relation to carditis.
• Examination of anatomical variations in the esophagogastric junction and cardia-type mucosa (CM) development.

Main Results:

• Carditis diagnosis relies on histological criteria, with proposed adaptation from the Sydney classification.
• H. pylori gastritis commonly involves the gastric cardia.
• The contribution of GERD to carditis in H. pylori-negative individuals is highly controversial, with reported prevalence in GERD patients ranging widely (10-97%).

Conclusions:

• Carditis, due to its high frequency and low specificity, is not currently considered a distinct clinical entity.
• Metaplastic cardia-type mucosa may develop in the esophagus due to GERD.
• Further research with precise biopsy protocols is needed to understand carditis's role in esophagogastric junction cancer incidence.