Diseases of the Esophagus (1998) 11, 101 105 © 1998 International Society for Diseases of the Esophagus/Harcourt Brace & Co. Ltd ORIGINAL ARTICLE 'Carditis': an objective histological marker for pathologic gastroesophageal reflux disease A. Csendes, G. Smok, P. Burdiles, H. Sagastume, J. Rojas, G. Puente, F. Quezada, O. Korn Department of Surgery and Pathology Clinical Hospital, University of Chile, Santiago, Chile SUMMARY. In a prospective endoscopic and bioptic study, 141 control subjects and 359 patients with symptoms of gastroesophageal reflux (GER) were included to determine the prevalence of cardial epithelium inflammation or 'carditis' and to determine the prevalence of Helicobacter pylori in this area. Two biopsies at the antrum, four distal to the squamous-columnar junction and two proximal in the esophageal mucosa, were taken. Patients with gastroesophageal reflux were divided into four groups, according to the severity of endoscopic findings: patients without esophagitis, patients with erosive esophagitis, patients with short-segment and long- segment Barrett's esophagus (BE). Control subjects had normal histological findings at the cardia in 90% of cases, fundic mucosa being present twice as cardial epithelium. Carditis was present in 8% of cases and intestinal metaplasia (IM) in 2%. On the con- trary, patients with GER had carditis in nearly 50% of cases. Intestinal metaplasia was present in 12% of cases with GER without esophagitis or erosive esophagitis, in 35% of cases with short-segment BE and in 65% of the cases with long-segment BE. IM at the antrum was present in only 5% of cases. Helicobacter pylori at the squa- mous-columnar junction was present in 13% of control subjects and in 30% of the patients with GER. It is con- cluded that carditis is an easy and objective marker for the presence of chronic gastroesophageal reflux and the presence of Helicobacter pylori at this region must be carefully evaluated in order to determine some pathogenic role for the development of Barrett's esophagus. INTRODUCTION Gastroesophageal reflux (GER) is the most frequent disease among adults in the USA and in Chile. 1 3 It is a chronic long-standing disease, capable of producing different degrees of injury to the esophageal mucosa, which are objectively confirmed by an upper endoscopy with biopsies of the distal esophageal mucosa. Recently, it has been suggested by the group of DeMeester that the gastric cardial epithelium, located at the gastroesophageal junction, is also vulnerable to the injurious effects of gastric content. 4,5 Therefore, the purposes of the present prospective study were: 1) to determine the prevalence of cardial inflammation or 'carditis' at the squamous- columnar junction in control subjects and in patients with different degrees of severity of reflux disease. Correspondence to: A. Csendes MD, Department of Surgery, Hospital J.J. Aguirre, Santos Dumont 999, Santiago, Chile. 2) to determine the prevalence of Helicobacter pylori at the gastroesophageal junction in these patients. MATERIAL AND METHODS Subjects studied In this prospective protocol, which began in October 1995 and ended in December 1996, 500 subjects were included, as follows: Control subjects: 141 cases, with a mean age of 44.5 years (range 15-80), 23% being male and 77% female. None of them presented any symptoms of gastro- esophageal reflux, nor had any received medication or operation for reflux disease. They corresponded either to subjects who were referred to endoscopy for a health normal control (86 cases) or some had dyspeptic symp- toms of irritable bowel syndrome and were submitted for a complete medical assessment (55 cases). Patients with gastroesophageal reflux: 359 cases, all of them with typical symptoms of chronic gastro- esophageal reflux (heartburn and/or regurgitation) of 101 Downloaded from https://academic.oup.com/dote/article/11/2/101/4371485 by guest on 28 December 2022