The pathology of gastric cardia: a prospective, endoscopic, and morphologic study.
"Carditis" (inflammation of the gastric cardiac mucosa) may be associated with gastroesophageal reflux disease (GERD), whereas other studies argue that Helicobacter pylori could play a significant role in the chronic cardiac damage. We examined prospectively histologic features of gastric cardia, esophagitis, and H. pylori status in 204 consecutive subjects with GERD symptoms (57.3% male, 42.7% female mean age 49.2 y) undergoing upper gastrointestinal endoscopy with multiple biopsies in the distal esophagus, cardiac region, and stomach. These were assessed for esophagitis landmarks [Ismail Beigi grading (g0-3)], gastritis, and H. pylori infection (Sydney classification). The average symptom duration was 10.8 months. Endoscopy showed no erosive disease in 54.5% patients, grade "A" esophagitis in 37.6%, "B" in 8%, and "C" in 1 case. Histologic examination disclosed g0 in 8.3% patients, g1 in 78.4%, g2 in 12.8%, and g3 in 1; analysis of the cardia showed oxyntic mucosa in 27.9% patients and chronic cardiac mucosa inflammation in 72.1%. Carditis was significantly related to macroscopic esophagitis (P=0.044) and heartburn score (P=0.001). H. pylori cardiac infection was present in 27.4% cases (73.2% associated with cardiac mucosa). Gastric H. pylori infection was demonstrated in 35% patients. H. pylori in the cardiac region was associated with gastric H. pylori infection (P=0.001) and with paucity of GERD symptoms (P=0.05). A good correlation between carditis and GERD, concerning symptoms and macroscopic esophagitis was found in this study. H. pylori-related carditis is likely to be differently compared with the GERD-related type.
Cestari
Renzo
R
Surgical Endoscopy Unit, Department of Clinical and Experimental Medicine, University of Perugia School of Medicine, Italy.
Villanacci
Vincenzo
V
Bassotti
Gabrio
G
Rossi
Elisa
E
Casa
Domenico Della
DD
Missale
Guido
G
Minelli
Luigi
L
Cengia
Paolo
P
Gambarotti
Marco
M
Pirali
Francesco
F
Donato
Francesco
F
Genta
Robert M
RM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D004942:Esophagitis, Peptic / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D006356:Heartburn / Q000209:etiology / Q000473:pathology; D016481:Helicobacter Infections / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013557:Switzerland / Q000453:epidemiology