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Acid exposure and reflux esophagitis

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Abstract

Reflux esophagitis is believed to be related to acid exposure, and it is tempting to assume that the extent of mucosal damage should correlate with pH-metering values. In order to test this hypothesis we studied 151 children with gastroesophageal reflux (GER) documented by X-ray manometry, and pH studies fiberendoscopically. Biopsies taken from each child were assigned to one of four grades according to degree of leukolyte infiltration, basal layer thickening, and papillary lengthening. Histologic esophagitis was demonstrated in 59% of cases, but was severe in only 4%. The histologic grade was independent of endoscopic evaluation, which, in addition, upgraded the lesions (73% esophagitis with 19.2% severe grades). It was also independent of the eventual need for surgery. On the other hand, esophagitis grade significantly correlated with percentage of time at pH below 4 (Spearman's r = 0.18, P < 0.05) and number of GER episodes (Spearman's r = 0.28, P < 0.01). Fiberendoscopic-histologic assessment of esophagitis has been useful in our hands as a complement to other diagnostic GER studies, but its value as an isolated procedure is questionable: it is probably very reliable in the relatively rare severe cases, but the clinical picture is so revealing in these cases as to make it unnecessary. In mild and moderate grades, which are much more frequent in children, it was not a suitable method for evaluating the severity of GER and did not assist in the establishment of surgical indications.

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Authors and Affiliations

  1. Department of Pediatrics, Divisions of Pediatric Surgery (F.I.S.S.S. Research Unit) and Pathology, Universidad del Pais Vasco, Hospital Materno-Infantil NaSa de Aranzazu, E-20014, San Sebastián, Spain

    J. A. Tovar, E. Blarduni, J. Torrado, J. Arana, J. Garay & I. Tapia

Authors
  1. J. A. Tovar
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  2. E. Blarduni
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  3. J. Torrado
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  4. J. Arana
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  5. J. Garay
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  6. I. Tapia
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Additional information

This investigation has been partially supported by F.I.S.S.S. grants 84/1049 and 87/1605

Offprint requests to: J. A. Tovar

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Tovar, J.A., Blarduni, E., Torrado, J. et al. Acid exposure and reflux esophagitis. Pediatr Surg Int 3, 326–330 (1988). https://doi.org/10.1007/BF00189170

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