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Clinical and endoscopic predictors of histological oesophagitis in infants
L M Chadwick1, J J Kurinczuk, L A Hallam
1Gastroenterology Department, TVW Telethon Institute for Child Health Research, Australia.
Insights
Histological changes, specifically intraepithelial lymphocytes, can diagnose infant oesophagitis before 4 months. Clinical symptoms and endoscopy are unreliable for diagnosis in infants with gastro-oesophageal reflux.
Area of Science:
- Pediatric Gastroenterology
- Histopathology
- Gastrointestinal Diseases
Background:
- Gastro-oesophageal reflux (GOR) is common in infants.
- Diagnosing oesophagitis in infants based on clinical symptoms or endoscopic findings can be challenging.
Purpose of the Study:
- To establish the earliest age for diagnosing infant oesophagitis using histological changes.
- To correlate clinical, endoscopic, and histological features of infant oesophagitis.
Main Methods:
- Retrospective review of 113 infants (2-18 months) with significant GOR undergoing oesophagoscopy.
- Independent evaluation and grading of biopsies by two pathologists.
Main Results:
- 40% of infants had histological oesophagitis; only 14% had abnormal endoscopic findings.
- Endoscopy showed high specificity (93%) but low sensitivity (25%) for histological oesophagitis.
- Intraepithelial lymphocytes were the earliest histological sign, present before 4 months; their numbers and other features increased with age.
Conclusions:
- Infant oesophagitis diagnosis is difficult to predict from symptoms alone.
- Intraepithelial lymphocytes are the earliest histological indicator of oesophagitis in infants with GOR, detectable before 4 months.
- Oesophagoscopy without biopsy is unreliable for diagnosing infant oesophagitis.
Objective:
To define the earliest age at which histological changes can be used to diagnose oesophagitis and to determine the relationships between clinical, endoscopic and histological features of oesophagitis in infants.
Methodology:
The case records and biopsies of 113 infants aged 2-18 months with clinically significant gastro-oesophageal reflux (GOR), undergoing oesophagoscopy between 1978 and 1994 were retrospectively reviewed. The biopsies were independently evaluated and graded by two pathologists.
Results:
Forty-five cases (40%) had histological oesophagitis but only 16 (14%) had abnormal endoscopic findings (excluding erythema). Endoscopy was found to be highly specific (93%) for histological oesophagitis but lacked sensitivity (25%). Irritability was inversely related to the presence of endoscopic abnormalities, and there was poor correlation between symptoms and histological changes with only haematemesis showing a statistically significant association with histological abnormalities (P = 0.033). Intraepithelial lymphocytes were the earliest of the histological features noted and were present before 4 months of age. The numbers of intraepithelial eosinophils and lymphocytes and the presence of papillary elongation all increased with age.
Conclusions:
The presence of oesophagitis is difficult to predict on the basis of symptoms. The presence of intraepithelial lymphocytes is the earliest histological change to be seen in infants with GOR, and can develop before 4 months of age. Oesophagoscopy without biopsy is unreliable in the diagnosis of oesophagitis in infants.