Histologic characterization of the squamocolumnar junction (SCJ) in children

Standard practice for pediatric esophagogastroduodenoscopy (EGD) has been to biopsy the esophagus at least 3 centimeters above the SCJ due to the concern that the histology of the distal 2-3cm of the esophagus may normally have characteristics of reflux. As part of a larger prospective study, standard pinch biopsies were obtained at the SCJ and 3cm proximaliy in the distal esophagus (DE) from all patients presenting for routine EGD. Results of the first 44 patients biopsied have been reviewed. Methods: A standardized questionnaire was used to obtain information regarding signs and symptoms of gastroesophageal reflux (GER) prior to EGD. Biopsies were reviewed by one of two pathologists in a blinded fashion to evaluate for histologic characteristics of GER esophagitis [presence of eosinophils (EOS), basal cell hyperplasia (BCH), elongation of papillae (EPAP)], and for intraepithelial lymphocytes. Results: Fourteen of 44 patients had EOS found in biopsies of the SCJ. Eight of these 14 had EOS found on biopsy of the DE. Only 2 patients had EOS found in the DE biopsy without EOS noted at the SCJ. EOS were statistically more likely to be found at either biopsy site when signs/symptoms of GER were the indication for EGD as compared to all other indications. GER Symptoms GER Symptoms + - +-Eosinophils + 12 2 Eosinophils + 9 1 @ SCJ - 14 16 @ DE - 17 17 X² = 6.02 p= 0.015 X²=5.11 p= 0.025 RR= 9.00 RR=6.86 The only characteristic of esophagitis that was statistically different between the SCJ and the DE was the more frequent presence of EPAP at the SCJ (P=0.0034). Intraepithelial lymphocytes were noted in all biopsies. Conclusions: The presence of EOS in esophageal biopsies correlated highly with signs/symptoms of GER. The presence of EOS at the SCJ appears to be specific to patients with GER symptoms. Although not statistically significant in this preliminary report, the higher frequency of EOS at the SCJ versus the DE may represent a more sensitive measure of esophagitis in GER. More patients will be necessary to make any further conclusions.