VERTICAL LINES IN DISTAL ESOPHAGEAL MUCOSA (VLEM) - A TRUE ENDOSCOPICMANIFESTATION OF ESOPHAGITIS IN CHILDREN

Background: We observed an endoscopic abnormality in a group of childr en with histological esophagitis. We termed this finding ''vertical li nes in esophageal mucosa'' (VLEM). We examined the relationship betwee n the presence of VLEM and significant histologic changes in esophagea l mucosal biopsies. Methods: Between January 1, 1992, and August 31, 1 994, the senior author (JFF) performed 255 esophageal biopsies. The pr ocedure reports, available endoscopic photographs, and histology repor ts were reviewed to establish the endoscopic and histologic appearance of the esophageal mucosa. Intraepithelial cells were counted in a bli nd review of 42 randomly selected biopsies. Results: The esophageal mu cosa had a normal appearance on 160 endoscopic studies (Group 1)and VL EM were the only mucosal abnormalities in 41 endoscopies (Group 2). Hi stology was normal in 92 of 160 biopsies (57.5%) from Group 1, and 1 o f 41 biopsies (2.4%) from Group 2. Most patients in Group 2 had eosino philic esophagitis (34 of 41, 83%, specificity 0.85, sensitivity 0.5, p < 0.001) which was of moderate to severe intensity(31 of 34, 91.2%, specificity 0.88, sensitivity 0.73, p < 0.081). Conclusions: Histology usually demonstrated moderate to severe inflammation when VLEM were p resent. VLEM may be a highly specific endoscopic feature of esophagiti s in children.