Gut 1999;45:798-803 ( December )

Article

Patterns of gastritis in patients with gastro-oesophageal reflux disease D J Bowrey^a, G W B Clark^a, G T Williams^b

^a University Department of Surgery, University of Wales College of Medicine, Cardiff, UK, ^b University Department of Pathology, University of Wales College of Medicine, Cardiff, UK

Correspondence to: Dr D J Bowrey, Department of Surgery, Nevill Hall Hospital, Brecon Road, Abergavenny, Monmouthshire NP7 7EG, UK.

Accepted for publication 23 June 1999

BACKGROUNDThe cause of inflammation in cardiac mucosa at the gastro-oesophageal junction (GOJ) is unclear, both gastro-oesophageal reflux disease (GORD) and Helicobacter pylori having been implicated.
AIMSTo describe patterns of gastritis in patients with symptomatic GORD.
METHODSIn 150 patients (126 normally located Z-line, 24 Barrett's oesophagus) with symptoms of GORD, biopsies were taken of the GOJ, corpus, and antrum. Inflammation was assessed using the updated Sydney System.
RESULTSFor the 126 patients with a normally located Z-line, biopsies of the GOJ revealed cardiac mucosa in 96, fundic mucosa in 29, and squamous mucosa in one. Inflammation in glandular mucosa at the GOJ was present in 99/125 specimens (79%), including 87/96 (91%) with cardiac mucosa and 12/29 (41%) with fundic mucosa. Inflammation in fundic mucosa was closely related to H pylori and active inflammation was only seen in its presence. Inflammation in cardiac mucosa was less closely linked to H pylori. When H pylori was present in cardiac mucosa (28/96, 29%) active inflammation was usually present (25/28, 89%). However, active inflammation was also found in 34/68 (50%) cardiac mucosa specimens without H pylori. Overall, 28/87 (32%) biopsies with carditis were colonised with H pylori and 59/87 (68%) were not. In H pylori colonised patients, inflammation was seen throughout the stomach, while in non-colonised patients, it was confined to cardiac mucosa.
CONCLUSIONSPatients with symptomatic GORD had a high prevalence of carditis. This was of two types, H pylori associated and unassociated. Except on Giemsa staining, the two were morphologically identical, suggesting mediation by a similar immunological mechanism.


Keywords: cardiac mucosa; carditis; gastro- oesophageal junction; gastro-oesophageal reflux; Helicobacter pylori; inflammation

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© 1999 by Gut
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