Characterization of the inflammatory infiltrate in peptic oesophagitis

Background The diagnosis of oesophagitis is mainly based on histology, but interpretation of endoscopic biopsies is often difficult. We performed immu nohistochemical studies on oesophageal biopsies to see if better characteri zation of the inflammatory cell infiltrate would improve the accuracy of th e histologic diagnosis of gastro-oesophageal disease. Methods. The study groups consisted of 40 consecutive children (mean age +/ -SD: 79.6+/-51.9 months; 20 boys) with gastro-oesophageal reflux disease an d 7 symptomatic children (mean age +/-SD: 52.6+/-37.0 months; 3 boys) witho ut gastro-oesophageal reflux disease. All patients underwent upper gastroin testinal endoscopy with oesophageal biopsies. The diagnosis of gastro-oesop hageal reflux disease was established by conventional endoscopic and histol ogic criteria. In each mucosal biopsy specimen, the number of intraepitheli al CD3+, CD25+ [IL2 receptor+), ICAM+, HLA-DR+ and mucosal mast cells were determined. Results. Conventional histology was in close agreement with endoscopic find ings (p<0.001) and reflected the clinical score even more than endoscopic f indings. Conventional histology significantly correlated with each inflamma tory immunohistochemical marker (<0.05 for each), but the markers were not predictive of symptom severity. Immunohistochemical markers were always abn ormal in the gastro-oesophageal reflux disease patients, even in the mildes t cases of oesophagitis. Conclusions. Although there is a good correlation between symptoms and hist ology, in a subset of patients, immunohistochemical studies appear useful i n supporting the histological diagnosis of gastro-oesophageal reflux diseas e.