Features of chronic inflammation at the gastric cardia and the relationship with Helicobacter pylori infection and oesophagitis.
BACKGROUND
The etiopathogenesis of chronic inflammation at the gastric cardia is still debated. It is suggested that carditis may be a finding of gastro-oesophageal reflux disease (GORD) or it may occur as a result of the gastritis caused by Helicobacter pylori (H. pylori) infection.


OBJECTIVE
To examine morphological features of carditis, as well as the associations of carditis with Helicobacter pylori gastritis and oesophagitis as a marker of gastro-oesophageal reflux disease.


METHODS
Endoscopic biopsy specimens obtained systematically from oesophagus, cardia, corpus and antrum of 135 dyspeptic patients were retrospectively evaluated. In biopsies, we have searched for any correlations between clinical, endoscopic, and histological features.


RESULTS
Carditis was detected in 123 (91.1%) of the cases. The mean age of the carditis group was 47.9 years and the male-to-female ratio was 1.08:1. The relation of carditis with age and sex was not significant (p = 0.19 and p = 0.24, respectively). All cases of the carditis group had concomitant chronic gastritis. In these cases, chronic inflammation, degree of neutrophil-mediated activity and H. pylori colonisation were significantly correlated in cardia, corpus and antrum (p < 0.001). Intestinal metaplasia was observed in 14 cases (11.3%) and, was associated with H. pylori colonisation (p < 0.001). Microscopic oesophagitis detected in 37.7% cases also showed correlation with reflux symptoms and endoscopic oesophagitis but not carditis. When all cases with carditis were evaluated for H. pylori infection and oesophagitis, which are presumed risk factors for carditis, H. pylori infection appeared to be an independent risk factor for carditis (p = 0.012), while oesophagitis did not.


CONCLUSIONS
This study suggests that carditis is commonly found in patients presenting with dyspepsia and the histological features of carditis were similar to those seen in H. pylori gastritis in antrum and corpus. In addition, our data have also shown that carditis was significantly associated with H. pylori infection but not with symptoms or signs of GORD.
Ayhan
Semin
S
Celal Bayar University Faculty of Medicine, Department of Pathology, Manisa, Turkey. ayhan@egenet.com.tr
Demir
Mehmet Akif
MA
Kandiloglu
Ali Riza
AR
Saruc
Murat
M
Kucukmetin
Nurten
N
D000328:Adult; D002299:Cardia / Q000382:microbiology / Q000473:pathology; D002908:Chronic Disease; D004415:Dyspepsia / Q000209:etiology; D004941:Esophagitis / Q000209:etiology*; D005260:Female; D005756:Gastritis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D005764:Gastroesophageal Reflux / Q000150:complications*; D016481:Helicobacter Infections / Q000150:complications* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies