Histological evaluation of esophageal mucosa in children with acid gastroesophageal reflux.

<strong>AIM</strong><br />histological evaluation of esophageal mucosa in children, with regard to the duration of primary acid gastroesophageal reflux (GER) and acid GER secondary to cow's milk allergy and/or other food allergy (CMA/FA) (prospective st...

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Main Authors: Maciej Kaczmarski, Janusz Semeniuk, Mirosława Uścinowicz, Maria Sobaniec-Łotowska
Format: Article
Language:English
Published: Via Medica 2009-12-01
Series:Folia Histochemica et Cytobiologica
Online Access:http://czasopisma.viamedica.pl/fhc/article/view/4353
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spelling doaj-a906026139a24684b160bb6bd26afb822020-11-24T22:43:53ZengVia MedicaFolia Histochemica et Cytobiologica0239-85081897-56312009-12-0147229730610.5603/4353Histological evaluation of esophageal mucosa in children with acid gastroesophageal reflux.Maciej KaczmarskiJanusz SemeniukMirosława UścinowiczMaria Sobaniec-Łotowska<strong>AIM</strong><br />histological evaluation of esophageal mucosa in children, with regard to the duration of primary acid gastroesophageal reflux (GER) and acid GER secondary to cow's milk allergy and/or other food allergy (CMA/FA) (prospective study).<br /><br /><strong>MATERIAL AND METHODS</strong><br />264 children of both sexes suspected of GER were enrolled in the study. The age of examined children was 1.5-102 months, mean age 20.78+/-17.23 months. Pathological acid GER was confirmed with pH-monitoring in 138 children (52.3%). Taking into consideration complex differential diagnosis, including oral food challenge test with potentially noxious nutrient (open or blind study), children were assigned into study groups 1 and 2 (primary and secondary GER). Group 1: 76 patients (28.8%) aged 4-102 months (x=25.2+/-27.28 months) with primary GER. Group 2: 62 patients (23.5%) aged 4-74 months (x=21.53+/-17.79 months) with GER secondary to CMA/FA. Children with GERD underwent preliminary and control (after 1 year and 2 years of GERD diagnosis) endoscopic examination of the upper gastroinestinal tract.<br /><br /><strong>RESULTS</strong><br />Intensity of esophagitis was assessed initially in 25 children from group 1 (32.9%), in 29 children from group 2 (46.8%), and in 9 children from group 3 - reference group (28.1%). Histological evaluation revealed infiltration of inflammatory cells, mainly neutrophils and intraepithelial lymphocytes, and also eosinophils in 10 children (13.2%) with primary GER. Infiltration of eosinophils and lymphocytes was found in 5 children (8.1%) with secondary GER. In 8 children (25.0%) with food allergy there were only lymphocytes. Infiltration of neutrophils and lymphocytes and basal zone hyperplasia or infiltration of eosinophils and lymphocytes with elongation of lamina propria papillae was found in 10 children (13.1%) with primary GER and in 20 children (32.2%) with secondary GER. Differentiation of particular types of inflammatory cells in mucosal infiltration characterized histological picture in the following way: neutrophils in 21 children (27.6%) with primary GER, eosinophils in 22 children (35.5%) with secondary GER, lymphocytes in 15 children (19.7%) in children with primary GER and in 15 children (24.2%) with secondary GER. Histological examination of esophageal mucosa after 1 and 2 years of clinical observation and periodical conservative treatment in children with primary and secondary GER revealed significant alleviation of inflammatory abnormalities (with regard to the type of abnormalities and the number of particular types of inflammatory cells).<br /><br /><strong>CONCLUSIONS</strong><br />The value of histological findings obtained in own studies comprises the role of food allergy in pathogenesis of GER and is related to GER's contribution, both direct (primary reflux) and indirect (secondary reflux), to triggering off morphological results and clinical outcomes of esophagitis.<br /><br />http://czasopisma.viamedica.pl/fhc/article/view/4353
collection DOAJ
language English
format Article
sources DOAJ
author Maciej Kaczmarski
Janusz Semeniuk
Mirosława Uścinowicz
Maria Sobaniec-Łotowska
spellingShingle Maciej Kaczmarski
Janusz Semeniuk
Mirosława Uścinowicz
Maria Sobaniec-Łotowska
Histological evaluation of esophageal mucosa in children with acid gastroesophageal reflux.
Folia Histochemica et Cytobiologica
author_facet Maciej Kaczmarski
Janusz Semeniuk
Mirosława Uścinowicz
Maria Sobaniec-Łotowska
author_sort Maciej Kaczmarski
title Histological evaluation of esophageal mucosa in children with acid gastroesophageal reflux.
title_short Histological evaluation of esophageal mucosa in children with acid gastroesophageal reflux.
title_full Histological evaluation of esophageal mucosa in children with acid gastroesophageal reflux.
title_fullStr Histological evaluation of esophageal mucosa in children with acid gastroesophageal reflux.
title_full_unstemmed Histological evaluation of esophageal mucosa in children with acid gastroesophageal reflux.
title_sort histological evaluation of esophageal mucosa in children with acid gastroesophageal reflux.
publisher Via Medica
series Folia Histochemica et Cytobiologica
issn 0239-8508
1897-5631
publishDate 2009-12-01
description <strong>AIM</strong><br />histological evaluation of esophageal mucosa in children, with regard to the duration of primary acid gastroesophageal reflux (GER) and acid GER secondary to cow's milk allergy and/or other food allergy (CMA/FA) (prospective study).<br /><br /><strong>MATERIAL AND METHODS</strong><br />264 children of both sexes suspected of GER were enrolled in the study. The age of examined children was 1.5-102 months, mean age 20.78+/-17.23 months. Pathological acid GER was confirmed with pH-monitoring in 138 children (52.3%). Taking into consideration complex differential diagnosis, including oral food challenge test with potentially noxious nutrient (open or blind study), children were assigned into study groups 1 and 2 (primary and secondary GER). Group 1: 76 patients (28.8%) aged 4-102 months (x=25.2+/-27.28 months) with primary GER. Group 2: 62 patients (23.5%) aged 4-74 months (x=21.53+/-17.79 months) with GER secondary to CMA/FA. Children with GERD underwent preliminary and control (after 1 year and 2 years of GERD diagnosis) endoscopic examination of the upper gastroinestinal tract.<br /><br /><strong>RESULTS</strong><br />Intensity of esophagitis was assessed initially in 25 children from group 1 (32.9%), in 29 children from group 2 (46.8%), and in 9 children from group 3 - reference group (28.1%). Histological evaluation revealed infiltration of inflammatory cells, mainly neutrophils and intraepithelial lymphocytes, and also eosinophils in 10 children (13.2%) with primary GER. Infiltration of eosinophils and lymphocytes was found in 5 children (8.1%) with secondary GER. In 8 children (25.0%) with food allergy there were only lymphocytes. Infiltration of neutrophils and lymphocytes and basal zone hyperplasia or infiltration of eosinophils and lymphocytes with elongation of lamina propria papillae was found in 10 children (13.1%) with primary GER and in 20 children (32.2%) with secondary GER. Differentiation of particular types of inflammatory cells in mucosal infiltration characterized histological picture in the following way: neutrophils in 21 children (27.6%) with primary GER, eosinophils in 22 children (35.5%) with secondary GER, lymphocytes in 15 children (19.7%) in children with primary GER and in 15 children (24.2%) with secondary GER. Histological examination of esophageal mucosa after 1 and 2 years of clinical observation and periodical conservative treatment in children with primary and secondary GER revealed significant alleviation of inflammatory abnormalities (with regard to the type of abnormalities and the number of particular types of inflammatory cells).<br /><br /><strong>CONCLUSIONS</strong><br />The value of histological findings obtained in own studies comprises the role of food allergy in pathogenesis of GER and is related to GER's contribution, both direct (primary reflux) and indirect (secondary reflux), to triggering off morphological results and clinical outcomes of esophagitis.<br /><br />
url http://czasopisma.viamedica.pl/fhc/article/view/4353
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