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Esophagitis in infants. Morphometric histological diagnosis and correlation with measures of gastroesophageal reflux
D D Black1, R C Haggitt, S R Orenstein
1Department of Pediatrics, University of Chicago Medical Center, Illinois.
Insights
Histological esophagitis is common in infants with gastroesophageal reflux symptoms. Esophageal biopsies accurately diagnose this condition, though its severity doesn't always correlate with reflux severity.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
- Infant Health
Background:
- Gastroesophageal reflux (GER) is a common condition in infants.
- Histological confirmation of esophagitis in infants with GER symptoms is crucial for accurate diagnosis and management.
- Standardized morphometric parameters for diagnosing infant reflux esophagitis are needed.
Purpose of the Study:
- To determine the incidence of histological esophagitis in infants under 2 years old presenting with GER symptoms.
- To establish normal morphometric values for esophageal histology in infants.
- To evaluate the correlation between histological findings and pH probe monitoring in diagnosing reflux esophagitis.
Main Methods:
- Esophageal suction biopsies and 24-hour pH probe monitoring were performed on 35 infants with GER symptoms.
- Histological analysis quantified intraepithelial inflammatory cells, basal cell layer thickness, and papillary height.
- Morphometric control values were derived from infant trauma victims; upper limits of normal were set at mean + 3 standard deviations.
Main Results:
- 77% of infants exhibited at least one abnormal histological parameter, indicating esophagitis.
- Histological measures of esophagitis demonstrated good internal consistency.
- Lamina propria eosinophilia showed high correlation with intraepithelial eosinophils (r=0.98), with 41% sensitivity and 89% specificity for histological esophagitis.
- 93% of infants with histological esophagitis had significant reflux by pH monitoring.
- Correlation between esophagitis severity and reflux severity was generally poor.
Conclusions:
- Esophageal suction biopsies are suitable for diagnosing reflux esophagitis in infants.
- Histological assessment of esophageal biopsies provides a reliable method for identifying esophagitis in infants with GER symptoms.
- While histological esophagitis often coexists with significant reflux, direct correlation of severity is limited.
Abstract:
To assess the incidence of histological esophagitis in infants less than 2 yr old with symptoms of gastroesophageal reflux, 35 infants were studied with esophageal suction biopsy and pH probe monitoring. Intraepithelial and lamina propria inflammatory cells, basal cell layer thickness, and papillary height were quantitated. Distal esophageal sections from infant sudden death trauma victims were used to provide normal morphometric control values. The upper limit of normal for each of the four histological parameters of esophagitis was defined as the mean plus three standard deviations. The values thus derived were similar to established adult normal values. Seventy-seven percent of the patients had at least one abnormal histological parameter (intraepithelial eosinophils or neutrophils, thickened basal cell layer, or increased papillary height) and were thus considered to have esophagitis. These measures of esophagitis all correlated well with each other, providing an internal consistency to the histological interpretation. Lamina propria eosinophilia correlated highly with intraepithelial eosinophils (r = 0.98) and was found to have a sensitivity of 41% and specificity of 89% for diagnosing histological esophagitis, defined as abnormality of any of the four histological parameters. Ninety-three percent of the patients with histological esophagitis had significant reflux as determined by pH probe monitoring. However, there was generally poor correlation between the severity of the esophagitis as quantitated by morphometric parameters and severity of the reflux as measured by pH monitoring. Esophageal suction biopsies, which provide adequate specimens for morphometric interpretation, are appropriate for diagnosing reflux esophagitis in infants.
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