Patterns of gastritis in patients with gastro-oesophageal reflux disease

Background-The cause of inflammation in cardiac mucose at the: gastrooesoph ageal junction (GOJ) is unclear, both gastro-oesophageal reflux disease (GO RD) and Helicobacter pylori having been implicated. Aims-To describe patter ns of gastritis in patients with symptomatic GORD. Methods-In 150 patients (126 normally located Z-line, 24 Barrett's oesophag us) with symptoms of GORD, biopsies were taken of the GOJ, corpus, and antr um. Inflammation was assessed using the updated Sydney System. Results-For the 126 patients with a normally located Z-line, biopsies of th e GOJ revealed cardiac mucosa in 96, fundic mucosa in 29, and squamous muco sa in one. Inflammation in glandular mucosa at the GOJ was present in 99/12 5 specimens (79%), including 87/96 (91%) with cardiac mucosa and 12/29 (41% ) with fundic mucosa. Inflammation in fundic mucosa was closely related to H pylori and active inflammation was only seen in its presence. Inflammatio n in cardiac mucosa was less closely linked to H pylori. When H pylori was present in cardiac mucosa (28/96, 29%) active inflammation was usually pres ent (25/28, 89%), However, active inflammation was also found in 34/68 (50% ) cardiac mucosa specimens without H pylori. Overall, 28/87 (32%) biopsies with carditis were colonised with H pylori and 59/87 (68%) were not, In H p ylori colonised patients, Inflammation was seen throughout the stomach, whi le in non-colonised patients, it was confined to cardiac mucosa. Conclusions-Patients with symptomatic GORD had a high prevalence of carditi s. This was of two types, H pylori associated and unassociated. Except on G iemsa staining, the two were morphologically identical, suggesting mediatio n by a similar immunological mechanism.