title: Vertical lines in distal esophageal mucosa (VLEM): a true endoscopic manifestation of esophagitis in children?
abstract: BACKGROUND
  We observed an endoscopic abnormally in a group of children with histological esophagitis. We termed this finding "vertical lines in esophageal mucosa" (VLEM). We examined the relationship between the presence of VLEM and significant histologic changes in esophageal mucosal biopsies.
  
  
  METHODS
  Between January 1, 1992, and August 31, 1994, the senior author (JFF) performed 255 esophageal biopsies. The procedure reports, available endoscopic photographs, and histology reports were reviewed to establish the endoscopic and histologic appearance of the esophageal mucosa. Intraepithelial cells were counted in a blind review of 42 randomly selected biopsies.
  
  
  RESULTS
  The esophageal mucosa had a normal appearance on 160 endoscopic studies (Group 1) and VLEM were the only mucosal abnormalities in 41 endoscopies (Group 2). Histology was normal in 92 of 160 biopsies (57.5%) from Group 1, and 1 of 41 biopsies (2.4%) from Group 2. Most patients in Group 2 had eosinophilic esophagitis (34 of 41, 83%, specificity 0.85, sensitivity 0.5, p > 0.001) which was of moderate to severe intensity (31 of 34, 91.2%, specificity 0.88, sensitivity 0.73, p < 0.001).
  
  
  CONCLUSIONS
  Histology usually demonstrated moderate to severe inflammation when VLEM were present. VLEM may be a highly specific endoscopic feature of esophagitis in children.
authors.affiliation: Division of Gastroenterology/Hepatology, James Whitcomb Riley Hospital for Children, Indiana University, School of Medicine, Indianapolis 46202-5225, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Gupta
authors.forename: J F
authors.initials: JF
authors.lastname: Fitzgerald
authors.forename: S K
authors.initials: SK
authors.lastname: Chong
authors.forename: J M
authors.initials: JM
authors.lastname: Croffie
authors.forename: M H
authors.initials: MH
authors.lastname: Collins
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002452:Cell Count; D002648:Child; D002675:Child, Preschool; D019160:Endosonography; D004941:Esophagitis / Q000000981:diagnostic imaging* / Q000473:pathology; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D015588:Observer Variation; D011897:Random Allocation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity