Background - Gastroesophageal reflux disease is a frequent cause of morbidity in childhood, including esophagitis and recurrent respiratory symptoms; however histological and morphometric studies in esophageal biopsies of children are scarce. Aim - To study histological and morphometric findings in children with reflux esophagitis. Patients and Methods - We studied 26 esophageal biopsies of children (mean age: 4.1 years ± 3.4) with reflux esophagitis, which prevailed in boys (84.6%); post-prandial vomiting (76.9%) and repetitive bronchopneumonia (38.5%) were the most frequent symptoms. The diagnosis was made by X-ray in 18, by pH evaluation in 5 and by scintilography in 3 patients. The control group was formed by seven children without reflux symptoms who died from meningococcemia or congenital heart malformation (mean age: 2.5 years ± 2.3). Histological variables were studied by hematoxylin-eosin and periodic acid of Schiff stain, inflammatory infiltrate, epithelial and basal layer thickness, papillary length and its ratio with the thickness of the epithelium. Morphometry was performed at a digital system connected to pro-image software. Student's t test, Mann-Whitney test, Fisher and Pearson's correlation methods were used for the statistical analysis. Results - Epithelial and basal zone thickness, papillary length and its rate with thickness of epithelium, among the reflux group patients were higher than the control group. Eosinophils, neutrophils and "balloon cells" were not observed in the control group. Intraepithelial capillaries occurred in 11 cases in the reflux group (mean diameter: 59 mum). Conclusion - Epithelial and basal zone thickness, papillary length and its ratio with thickness of epithelium, resulted greater in the gastroesophageal reflux group than in the control group. There was a direct correlation between thickness of epithelium, basal zone thickness and papillary length, showing increased epithelial cell turnover. Eosinophils, neutrophils and "balloon cells" were observed only in patients with gastroesophageal reflux, thus serving as specific markers of this disease.
Esophagitis, peptic; Esophagus; Child
