Does carditis have two different etiologies?

Carditis has become the subject of much study and discussion, although its etiology is still controversial. We wished to study the prevalence and poss ible pathogenetic mechanisms of carditis in a well-defined group of patient s. In 664 patients biopsies were taken distal to the squamocolumnar junctio n (SCJ) and from the endoscopically defined cardia (2 cm below proximal mar gin of gastric folds). Specimens were stained with hematoxylin and eosin, A lcian blue, and modified Giemsa. Type of mucosa, inflammatory and metaplast ic changes, and presence of Helicobacter pylori (Hp) were graded. Most of t he patients had a normal appearing SCJ on endoscopy; 19.3% had short column ar segments (1-3 cm). In the first group cardiac/mixed mucosa was found in 71.9% of SCJ biopsies, and carditis (90.6%) was associated with Hp. In the second group, cardiac/mixed mucosa was present in 80.5%. There was a trend for an association between carditis (87.4%) and reflux esophagitis and hiat al hernia. Biopsies from the endoscopically defined cardia rarely contained cardiac/mixed mucosa (12.6%). These findings suggest two etiologies for ca rditis. In a normal-appearing SCJ carditis is associated with Hp, whereas i n an irregular SCJ with short columnar segments/tongues carditis is associa ted with features of gastroesophageal reflux.