Steiner Steven J, Kernek Kevin M, Fitzgerald Joseph F
Division of Pediatric Gastroenterology/Hepatology/Nutrition, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Ind 46202-5225, USA.
J Pediatr Gastroenterol Nutr. 2006 May;42(5):506-9. doi: 10.1097/01.mpg.0000221906.06899.1b.
Basal cell hyperplasia of the esophageal epithelium is a frequent finding in children with histological evidence of esophagitis. The aim of this study was to compare the severity of basal cell hyperplasia in gastroesophageal reflux vs eosinophilic esophagitis.
A cohort of pediatric patients who underwent same-day endoscopy with esophageal biopsy and 24-hour esophageal pH monitoring was divided into groups based on endoscopic and pH monitoring findings. Basal cell hyperplasia was defined as normal (< or = 25% of esophageal epithelial height), mild (26%-50%), moderate (51%-75%) or severe (> 75%). The severity of basal cell hyperplasia in patients with abnormal pH monitoring studies, both with and without endoscopic abnormalities of the esophagus, was compared with the severity in patients with eosinophilic esophagitis.
Twenty-seven children with abnormal pH monitoring were identified. Of these 27 children, 11 had endoscopic findings consistent with reflux esophagitis. Thirty patients with eosinophilic esophagitis were identified. Patients with eosinophilic esophagitis had significantly increased severity (P < 0.001) of basal cell hyperplasia (87% severe, 3% moderate, 3% mild, 7%, normal) than patients with abnormal esophageal pH monitoring alone (11% severe, 4% moderate, 15% mild, 70% normal) or in combination with endoscopic abnormalities (18% severe, 9% moderate, 18% mild, 55% normal).
Basal cell hyperplasia is more severe in children with eosinophilic esophagitis than in those with reflux esophagitis. The finding of basal cell hyperplasia is a powerful clue into the underlying etiology of pediatric esophagitis and, along with epithelial eosinophil count, can be used as information to guide therapy.
食管上皮基底细胞增生在有食管炎组织学证据的儿童中很常见。本研究的目的是比较胃食管反流与嗜酸性食管炎中基底细胞增生的严重程度。
一组接受当日内镜下食管活检及24小时食管pH监测的儿科患者，根据内镜和pH监测结果分组。基底细胞增生定义为正常（≤食管上皮高度的25%）、轻度（26%-50%）、中度（51%-75%）或重度（>75%）。将pH监测异常的患者（无论有无食管内镜异常）中基底细胞增生的严重程度与嗜酸性食管炎患者的严重程度进行比较。
确定了27例pH监测异常的儿童。在这27例儿童中，11例内镜检查结果符合反流性食管炎。确定了30例嗜酸性食管炎患者。嗜酸性食管炎患者的基底细胞增生严重程度（87%为重度，3%为中度，3%为轻度，7%为正常）显著高于单纯食管pH监测异常的患者（11%为重度，4%为中度，15%为轻度，70%为正常）或合并内镜异常的患者（18%为重度，9%为中度，18%为轻度，55%为正常）（P<0.001）。
嗜酸性食管炎患儿的基底细胞增生比反流性食管炎患儿更严重。基底细胞增生的发现是小儿食管炎潜在病因的有力线索，与上皮嗜酸性粒细胞计数一起可作为指导治疗的信息。
