Oesophageal subepithelial fibrosis: an extension of oral submucosal fibrosis

Fifty-five patients with oral submucosal fibrosis and an equal number of pa tients with no evidence of the disease were studied. All patients underwent upper gastrointestinal endoscopy and any abnormality was noted. Multiple o esophageal biopsies were obtained from the upper end of the oesophagus and from any endoscopically observed abnormality. The histological changes in t he two groups were assessed blindly by an experienced histopathologist. His tological abnormalities were noted in the oesophageal mucosa in 2% of contr ols and 66% of patients with oral submucosal fibrosis (p < 0.0001). In the control group, acanthosis was seen in one patient, while in the patient gro up atrophy of the squamous epithelium was evident in 52%, hyperkeratosis in 52%, parakeratosis in 30%, dyskeratosis in 14%, acanthosis in 14%, and pap illomatosis and mild dysplasia in 2% patients. Subepithelial collagenizatio n was seen in 32 (64%) patients. The oesophageal abnormalities were seen mo re frequently in patients who had consumed Pan masala, Gutka, betel nut, to bacco or a combination of some or all of these, with or without betel leaf, for greater than or equal to 5 years compared to those consuming them for a shorter period of time (91% us 46%, p < 0.001). It is concluded that oral submucosal fibrosis is not a disease confined to the oral cavity; the oeso phagus may also be involved in about two-thirds of patients.