Related Experiment Videos
Esophagitis: a frequent consequence of gastroesophageal reflux in infancy
Insights
Histologic esophagitis is common in infants with significant gastroesophageal reflux (GER), often without visible endoscopic signs. Intraepithelial eosinophils are key indicators of this inflammation.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
Background:
- Gastroesophageal reflux (GER) is a common condition in infants.
- Accurate diagnosis of esophagitis in infants requires clear histologic criteria.
Purpose of the Study:
- To establish diagnostic criteria for histologic esophagitis in infants.
- To determine the prevalence and characteristics of esophagitis in infants with clinically significant GER.
Main Methods:
- Reviewed esophageal biopsy specimens from 33 infants (<2 years) with clinically significant GER.
- Defined histologic esophagitis as ≥4 intraepithelial neutrophils or ≥1 eosinophil per high power field, or both.
- Correlated histologic findings with endoscopic evidence and patient age.
Main Results:
- Sixty-one percent (20/33) of infants had histologic esophagitis.
- Histologic esophagitis was frequently found in infants with normal endoscopic appearance (52%).
- Older infants (7-24 months) showed a higher likelihood of moderate to severe inflammation (P=0.01).
- Intraepithelial eosinophils were sensitive markers for acute inflammation in GER.
Conclusions:
- Esophagitis is prevalent in infants with significant GER.
- Histologic findings are crucial for diagnosing esophagitis, even without endoscopic abnormalities.
- Age is a factor in the severity of esophagitis in infants with GER.
Abstract:
A control group of infants was evaluated to determine criteria for the diagnosis of histologic esophagitis. Based on our observations, histologic esophagitis was defined as four or more intraepithelial neutrophils or one eosinophil per high power field or both. Esophageal biopsy specimens from 33 consecutive infants younger than 2 years who had been examined for clinically significant gastroesophageal reflux (GER) were reviewed for histologic esophagitis. Endoscopy had been performed in each patient, and 4.1 +/- 1.1 (mean +/- SD) biopsy specimens had been obtained above the distal 20% of the esophagus. Twenty (61%) infants had histologic esophagitis, including 15 with intraepithelial eosinophils alone, one with intraepithelial neutrophils alone, and four with both. Older infants (7 to 24 months) with histologic esophagitis were more likely to have moderate to severe inflammation than were infants younger than 7 months of age (P = 0.01). Endoscopic evidence for gross esophagitis was found in six (18%) infants; of these, five had abnormal biopsies, including four with moderate to severe inflammation. Among the 27 infants with a grossly normal esophagus, 14 (52%) had histologic esophagitis, including nine (33%) with moderate to severe inflammation. We conclude that in infants with clinically significant GER: (1) esophagitis is common, (2) histologic esophagitis frequently occurs in the absence of gross endoscopic findings, (3) the likelihood of moderate to severe inflammation increases after 6 months of age, and (4) intraepithelial eosinophils are a sensitive marker for acute inflammation in association with GER.