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. 1999 Dec;45(6):798–803. doi: 10.1136/gut.45.6.798

Patterns of gastritis in patients with gastro-oesophageal reflux disease

D Bowrey 1, G Clark 1, G Williams 1
PMCID: PMC1727740  PMID: 10562575

Abstract

BACKGROUND—The 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.
AIMS—To describe patterns of gastritis in patients with symptomatic GORD.
METHODS—In 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.
RESULTS—For 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.
CONCLUSIONS—Patients 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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Figure 1  .

Figure 1  

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Histology of gastro-oesophageal junction biopsy specimens for the 126 patients with a normally located Z-line. Patients have been subdivided according to mucosal type (cardiac, fundic, squamous) and Helicobacter pylori status. The prevalence of intestinal metaplasia in the gastro-oesophageal junction specimens is indicated.

Figure 2  .

Figure 2  

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Prevalence of neutrophil and mononuclear cell infiltration in columnar mucosa obtained from biopsy specimens of the gastro-oesophageal junction in 126 patients with a normally positioned Z-line. For each type of columnar mucosa prevalence of inflammatory cell infiltration is presented according to the presence or absence of Helicobacter pylori infection. Note the high prevalence of acute and chronic inflammation in cardiac type mucosa which was unrelated to H pylori. *p<0.05 v fundic H pylori negative, **p<0.01 v cardiac H pylori negative or fundic H pylori negative, †p<0.01 v fundic H pylori negative.

Figure 3  .

Figure 3  

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Prevalence of neutrophil infiltration in columnar mucosa at different locations throughout the stomach for 96 patients with reflux symptoms and cardiac type mucosa on biopsy of the gastro-oesophageal junction. The patients are stratified into Helicobacter pylori positive (n=28) and H pylori negative (n=68). *p<0.05 v fundic H pylori negative and antral H pylori negative, †p<0.05 v all sites in non-colonised individuals, ‡p<0.05 v fundic H pylori negative and antral H pylori negative.

Figure 4  .

Figure 4  

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Prevalence of mononuclear cell infiltration in columnar mucosa at different locations throughout the stomach for 96 patients with reflux symptoms and cardiac type mucosa on biopsy of the gastro-oesophageal junction. The patients are stratified into Helicobacter pylori positive (n=28) and H pylori negative (n=68). *p<0.05 v fundic H pylori negative and antral H pylori negative, **H pylori positive versus H pylori negative.

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