CLINICAL AND ENDOSCOPIC PREDICTORS OF HISTOLOGICAL ESOPHAGITIS IN INFANTS

Objective: To define the earliest age at which histological changes ca n be used to diagnose oesophagitis and to determine the relationships between clinical, endoscopic and histological features of oesophagitis in infants. Methodology: The case records and biopsies of 113 infants aged 2-18 months with clinically significant gastro-oesophageal reflu x (GOR), undergoing oesophagoscopy between 1978 and 1994 were retrospe ctively reviewed. The biopsies were independently evaluated and graded by two pathologists. Results: Forty-five cases (40%) had histological oesophagitis but only 16 (14%) had abnormal endoscopic findings (excl uding erythema). Endoscopy was found to be highly specific (93%) for h istological oesophagitis but lacked sensitivity (25%). Irritability wa s inversely related to the presence of endoscopic abnormalities, and t here was poor correlation between symptoms and histological changes wi th only haematemesis showing a statistically significant association w ith histological abnormalities (P = 0.033). Intraepithelial lymphocyte s were the earliest of the histological features noted and were presen t before 4 months of age. The numbers of intraepithelial eosinophils a nd lymphocytes and the presence of papillary elongation all increased with age. Conclusions: The presence of oesophagitis is difficult to pr edict on the basis of symptoms. The presence of intraepithelial lympho cytes is the earliest histological change to be seen in infants with G OR, and can develop before 4 months of age. Oesophagoscopy without bio psy is unreliable in the diagnosis of oesophagitis in infants.