title: Intraepithelial cells with irregular nuclear contours as a marker of esophagitis in children with gastroesophageal reflux disease.
abstract: The diagnostic usefulness of intraepithelial cells with irregular nuclear contours (CINC) (squiggle cells) in esophageal biopsies was investigated in 76 children (range age: 6 months-12 years) with gastroesophageal reflux disease. A further 20 subjects (range age: 10 months-11 years) served as controls. Based on the microscopic changes of the esophagus, according to traditional histological criteria, four groups of patients were identified; esophagitis was severe in 27, moderate in 20, mild in 21, and 8 patients had no clear-cut evidence of microscopic esophagitis. Data are given as mean +/- SD. Intraepithelial CINC had an immunohistochemical profile consistent with T lymphocytes. Patients with severe esophagitis had a CINC density (number per high-power filed) (9.0 +/- 3.5) significantly higher than patients with mild esophagitis (7.0 +/- 3.0) and those without evidence of microscopic esophagitis (6.5 +/- 1.9) (P < 0.05), but not different from those with moderate esophagitis (8.0 +/- 3.6); in all patients groups the CINC density was higher than in controls (2.2 +/- 0.3) (P < 0.01). The percentage of reflux at 24-hr intraesophageal pH monitoring was higher in severe esophagitis patients (11.4 +/- 6.0) as compared to the other groups (moderate: 7.8 +/- 6.3; mild: 6.5 +/- 3.6; no microscopic esophagitis: 6.3 +/- 2.0; P < 0.05). There was no correlation between CINC density and the amount of intraesophageal acid exposure in all patients. Furthermore, 27 of our patients had a normal intraesophageal acid exposure at the prolonged pH test (24-hr % of reflux < or = 4.5): the CINC density was significantly higher in them than in the controls.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Pediatrics, University of Naples Federico II, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cucchiara
authors.forename: F
authors.initials: F
authors.lastname: D'Armiento
authors.forename: E
authors.initials: E
authors.lastname: Alfieri
authors.forename: L
authors.initials: L
authors.lastname: Insabato
authors.forename: R
authors.initials: R
authors.lastname: Minella
authors.forename: T M
authors.initials: TM
authors.lastname: De Magistris
authors.forename: A
authors.initials: A
authors.lastname: Scoppa
mesh_terms: D001706:Biopsy; D002452:Cell Count; D002467:Cell Nucleus / Q000648:ultrastructure; D002648:Child; D002675:Child, Preschool; D004848:Epithelium / Q000648:ultrastructure; D004942:Esophagitis, Peptic / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D004947:Esophagus / Q000378:metabolism / Q000648:ultrastructure*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D013601:T-Lymphocytes / Q000473:pathology