ANALYSIS OF GASTRODUODENITIS AND ESOPHAGITIS IN RELATION TO DYSPEPTICREFLUX SYMPTOMS/

Background/Aims: The pathogenesis of dyspeptic/reflux symptoms and the clinico-pathologic profile of affected patients are still poorly unde rstood. To improve our knowledge in this field we carried out a system atic, comparative analysis of symptom profiles and histopathologic pat terns of oesophagogastroduodenal mucosa in a series of 221 subjects, 1 40 with and 81 without endoscopic evidence of hiatal hernia. Of these, 190 showed reflux and/or dyspeptic symptoms. Methods: Before endoscop y, all the subjects were questioned about the presence and severity of 12 individual symptoms. Biopsies were taken from the distal oesophagu s, cardia, corpus, angulus, antrum and duodenal bulb, and were scored in accordance with the Sydney system. Results: Patient groups with a d istinct clinico-pathologic profile were better identified when symptom s of adequate severity were compared with histopathologic parameters. A correlation between gastroesophageal reflux disease (GORD) symptoms and histologic signs of oesophagitis was mostly restricted to patients endoscopically positive for oesophagitis. Retroxiphoid pyrosis correl ated with cardial gastritis but not with oesophagitis, either endoscop ic or histologic, while ulcer-like epigastric pain correlated with act ive duodenitis and distal gastritis. No definite histopathologic backg round was detected in patients with putative dysmotility-like symptoms , endoscopy-negative GORD and low score or mixed symptoms. Conclusion: A contribution of Helicobacter pylori gastroduodenitis to the pathoge nesis of some dyspeptic symptoms seems likely. However, the identifica tion of specific histologic changes causing individual symptoms remain s rather elusive, with the exception of active antroduodenitis in pati ents with ulcer-like pain and of active proximal gastritis in patients with severe retroxiphoid pyrosis.