INTRAEPITHELIAL CELLS WITH IRREGULAR NUCLEAR CONTOURS AS A MARKER OF ESOPHAGITIS IN CHILDREN WITH GASTROESOPHAGEAL REFLUX DISEASE

The diagnostic usefulness of intraepithelial cells with irregular nucl ear contours (CINC) (squiggle cells) in esophageal endoscopic biopsies was investigated in 76 children (range age: 6 months-12 years) with g astroesophageal reflux disease. A further 20 subjects (range age: 10 m onths-11 years) served as controls, Based on the microscopic changes o f the esophagus, according to traditional histological criteria, four groups of patients were identified: esophagitis was severe in 27, mode rate in 20, mild in 21, and 8 patients had no clear-cut evidence of mi croscopic 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 field) (9.0 +/- 3.5) significantly higher than patients with mil d esophagitis (7.0 +/- 3.0) and those without evidence of microscopic esophagitis (6.5 +/- 1.9) (P < 0.05), but not different from those wit h moderate esophagitis (8.0 +/- 3.6); in all patient groups the CINC d ensity was higher than in controls (2.2 +/- 0.3) (P < 0.01). The perce ntage of reflux at 24-hr intraesophageal pH monitoring was higher in s evere esophagitis patients (11.4 +/- 6.0) as compared to the other gro ups (moderate: 7.8 +/- 6.3; mild: 6.5 +/- 3.6; no microscopic esophagi tis: 6.3 +/- 2.0; P < 0.05). There was no correlation between CINC den sity and the amount of intraesophageal acid exposure in all patients. Furthermore, 27 of our patients had a normal intraesophageal acid expo sure at the prolonged pH test (24-hr % of reflux less than or equal to 4.5): the CINC density was significantly higher in them than in the c ontrols. We conclude that intraepithelial CINC in esophageal endoscopi c biopsies from children with reflux disease represent a sensitive and early criterion of esophageal mucosa damage; they should be scanned i n addition to the traditional histological parameters of acid-related esophageal inflammation.