Fundal gastritis as a potential cause of reflux oesophagitis

The transient lower oesophageal sphincter relaxations which allow reflux ma y be due to altered afferent pathways from the fundus. We aimed to determin e whether fundal inflammation is the underlying cause. Two endoscopic biops ies were taken from each of the gastric antrum and fundus in 25 asymptomati c controls with a normal endoscopy (median age 54 range 13-83 years), and 3 3 patients with erosive oesophagitis (median age 52, 11-78 years). No patie nt had taken acid suppression therapy or antibiotics for at least 1 month. Sections were stained with haematoxylin and eosin and Giemsa stain and exam ined in a blinded fashion by one pathologist for the presence of gastritis (Sydney classification) and Helicobacter pylori. Chronic gastritis was comm on in both groups, but was usually mild. In Helicobacter pylori-negative su bjects, there was significantly less chronic gastritis in the antrum and th e fundus in oesophagitis patients than in controls (p < 0.05). When present , gastric atrophy was usually antral and mild in severity. There was no dif ference in the incidence of gastric atrophy in patients with oesophagitis c ompared with controls (24% compared with 40%; p > 0.05). Chronic gastritis is not more common in patients with oesophagitis, and is unlikely to play a part in the pathogenesis of this disease.