Skip to main content

Advertisement

SpringerLink
Log in

Effect of Proton Pump Inhibitor Therapy on Inflammatory Changes in the Gastric Cardia (Carditis)

  • Original Paper
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

The etiology of inflammation of the gastric cardia (carditis) is controversial, and gastroesophageal reflux disease (GERD) and H. pylori infection have been proposed as etiological factors. This study aimed to investigate the effect of acid suppression on histological changes in the gastric cardia. Gastric cardia biopsies of reflux patients were evaluated at baseline and after proton pump inhibitor (PPI) therapy. The updated Sydney classification was used to score the biopsies, and carditis scores (pre- and post-PPI therapy) were compared. A total of 31 patients were included, of which 5 patients were excluded, as cardiac mucosa was not documented in either pre- or post-PPI biopsies. The mean duration of PPI therapy was 30 months (SE, 3.04 months). There was no significant change in carditis scores post-PPI therapy. The mean mononuclear and neutrophil scores were 1.23 and 0.35 pre-PPI therapy and 1.73 and 0.62 post-PPI therapy, respectively. No change in mean intestinal metaplasia and atrophy scores was identified.

In conclusion, acid suppressive therapy with PPI did not lead to a significant reduction in carditis scores. These results suggest that GERD probably does not play a major role in the pathogenesis of inflammation in the gastric cardia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Corley DA, Kubo A (2004) Influence of site classification on cancer incidence rates: an analysis of gastric cardia carcinomas. J Natl Cancer Inst 96:1383–1387

    Article  PubMed  Google Scholar 

  2. Pohl H, Welch HG (2005) The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 97:142–146

    Article  PubMed  Google Scholar 

  3. El-Serag HB, Mason AC, Petersen N, Key CR (2002) Epidemiological differences between adenocarcinoma of the oesophagus and adenocarcinoma of the gastric cardia in the USA. Gut 50:368–372

    Article  PubMed  CAS  Google Scholar 

  4. Brown LM, Devesa SS (2002) Epidemiologic trends in esophageal and gastric cancer in the United States. Surg Oncol Clin North Am 11:235–256

    Article  Google Scholar 

  5. Kubo A, Corley DA (2004) Marked multi-ethnic variation of esophageal and gastric cardia carcinomas within the United States. Am J Gastroenterol 99:582–588

    Article  PubMed  Google Scholar 

  6. Blot WJ, Devesa SS, Kneller RW, Fraumeni Jr JF (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265:1287–1289

    Article  PubMed  CAS  Google Scholar 

  7. Botterweck AA, Schouten LJ, Volovics A, et al. (2003) Trends in incidence of adenocarcinoma of the esophagus and gastric cardia in ten European countries. Int J Epidemiol 29:645–654

    Article  Google Scholar 

  8. Daly JM, Karnell LH, Menck HR (1996) National Cancer Data Base report on esophageal carcinoma. Cancer 78:1820–1828

    Article  PubMed  CAS  Google Scholar 

  9. Kilgore SP, Ormsby AH, Gramlich TL, et al. (2000) The gastric cardia: fact or fiction? Am J Gastroenterol 95(4):921–924

    Article  PubMed  CAS  Google Scholar 

  10. Derdoy JJ, Bergwerk A, Cohen H, et al. (2003) The gastric cardia: To be or not to be? Am J Surg Pathol 27(4):499–504

    Article  PubMed  Google Scholar 

  11. Glickman, JN, Fox V, Antonioli DA, et al. (2002) Morphology of the cardia and significance of carditis in pediatric patients. Am J Surg Pathol 26(8):1032–1039

    Article  PubMed  Google Scholar 

  12. Zhou H, Greco MA, Daum F, Kahn E (2001) Origin of cardiac mucosa: ontogenic consideration. Pediatr Dev Pathol 4(4):358–363

    Article  PubMed  CAS  Google Scholar 

  13. Park YS, Park HJ, Kang GH, et al. (2003) Histology of gastroesophageal junction in fetal and pediatric autopsy. Arch Pathol Lab Med 127(4):451–455

    PubMed  Google Scholar 

  14. Sharma P, Topalovski M, Mayo MS, et al. (2000) Helicobacter pylori eradication dramatically improves inflammation in the gastric cardia. Am J Gastroenterol 95(11):3107–3111

    Article  PubMed  CAS  Google Scholar 

  15. El-Zimaity, Verghese VJ, Ramchatesingh J, Graham DY (2000) The gastric cardia in gastro-oesophageal disease. J Clin Pathol 53(8):619–625

  16. Lembo T, Ippoliti AF, Ramers C, Weinstein WM (1999) Inflammation of the gastro-oesophageal junction (carditis) in patients with symptomatic gastro-oesophageal reflux disease: a prospective study. Gut 45(4):484–488

    Article  PubMed  CAS  Google Scholar 

  17. Der R, Tsao-Wei DD, Demeester T, et al. (2001) Carditis: a manifestation of gastroesophageal reflux disease. Am J Surg Pathol 25(2):245–252

    Article  PubMed  CAS  Google Scholar 

  18. Zentilin P, Mastracci L, Dulbecco P, et al. (2004) Carditis in patients with gastro-oesophageal reflux disease: results of a controlled study based on both endoscopy and 24-h oesophageal pH monitoring. Aliment Pharmacol Ther 19(12):1285–1292

    Article  PubMed  CAS  Google Scholar 

  19. Oberg S, Peters JH, DeMeester TR, et al. (1997) Inflammation and specialized intestinal metaplasia of cardiac mucosa is a manifestation of gastroesophageal reflux disease. Ann Surg 226(4):522–530

    Article  PubMed  CAS  Google Scholar 

  20. Csendes A, Smok G, Burdiles P, et al. (1998) ‘Carditis’: an objective histological marker for pathologic gastroesophageal reflux disease. Dis Esophagus 11(2):101–105

    PubMed  CAS  Google Scholar 

  21. Dixon MF, Genta RM, Yardley JH, Correa P (1996) Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 20(10):1161–1181

    Article  PubMed  CAS  Google Scholar 

  22. Sharma P, McElhinney C, Topalovski M, et al. (2004) Detection of cardia intestinal metaplasia: Do the biopsy number and location matter? Am J Gastroenterol 99(12):2424–2428

    Article  PubMed  Google Scholar 

  23. McClave SA, Boyce Jr HW, Gottfried MR (1987) Early diagnosis of columnar-lined esophagus: a new endoscopic diagnostic criterion. Gastrointest Endosc 33(6):413–416

    Article  PubMed  CAS  Google Scholar 

  24. El-Serag HB, Sonnenberg A (1998) Opposing time trends of peptic ulcer and reflux disease. Gut 43(3):327–333

    Article  PubMed  CAS  Google Scholar 

  25. Chandrasoma PT, Der R, Ma Y, et al. (2000) Histology of the gastroesophageal junction: an autopsy study. Am J Surg Pathol 24(3):402–409

    Article  PubMed  CAS  Google Scholar 

  26. Chandrasoma PT, Lokuhetty DM, DeMeester TR, et al. (2000) Definition of histopathologic changes in gastroesophageal reflux disease. Am J Surg Pathol 24(3):344–351

    Article  PubMed  CAS  Google Scholar 

  27. Morini, S, Zullo A, Hassan C, et al. (2001) Gastric cardia inflammation: role of Helicobacter pylori infection and symptoms of gastroesophageal reflux disease. Am J Gastroenterol 96(8):2337–2340

    Article  PubMed  CAS  Google Scholar 

  28. El-Serag HB, Sonnenberg A, Jamal MM, et al. (1999) Characteristics of intestinal metaplasia in the gastric cardia. Am J Gastroenterol 94(3):622–627

    Article  PubMed  CAS  Google Scholar 

  29. Goldblum JR, Vicari JJ, Falk GW, et al. (1998) Inflammation and intestinal metaplasia of the gastric cardia: the role of gastroesophageal reflux and H. pylori infection. Gastroenterology 114(4):633–639

    Article  PubMed  CAS  Google Scholar 

  30. Chen YY, Antonioli DA, Spechler SJ, et al. (1998) Gastroesophageal reflux disease versus Helicobacter pylori infection as the cause of gastric carditis. Mod Pathol 11(10):950–956

    PubMed  CAS  Google Scholar 

  31. Goldblum JR, Richter JE, Vaezi M, et al. (2002) Helicobacter pylori infection, not gastroesophageal reflux, is the major cause of inflammation and intestinal metaplasia of gastric cardiac mucosa. Am J Gastroenterol 97(2):302–311

    Article  PubMed  Google Scholar 

  32. Van Der Hulst RW, Van Der Ende A, Dekker FW, et al. (1997) Effect of Helicobacter pylori eradication on gastritis in relation to cagA: a prospective 1-year follow-up study. Gastroenterology 113(1):25–30

    Article  PubMed  CAS  Google Scholar 

  33. Witteman EM, Mravunac M, Becx MJ, et al. (1995) Improvement of gastric inflammation and resolution of epithelial damage one year after eradication of Helicobacter pylori. J Clin Pathol 48(3):250–256

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This work was supported by the Veterans Affairs Medical Center, Kansas City, Missouri.

Author information

Authors and Affiliations

  1. University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Kansas, Missouri, USA

    Shailender Singh, Ajay Bansal, Srinivas Puli, Sachin Wani, Sharad Mathur, Amit Rastogi & Prateek Sharma

  2. Gastroenterology (111), Department of Veterans Affairs Medical Center, 4801 East Linwood Boulevard, Kansas City, Missouri, 64128-2295, USA

    Prateek Sharma

Authors
  1. Shailender Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ajay Bansal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Srinivas Puli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sachin Wani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sharad Mathur
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amit Rastogi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Prateek Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prateek Sharma.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singh, S., Bansal, A., Puli, S. et al. Effect of Proton Pump Inhibitor Therapy on Inflammatory Changes in the Gastric Cardia (Carditis). Dig Dis Sci 52, 2178–2182 (2007). https://doi.org/10.1007/s10620-006-9688-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-006-9688-x

Keywords

Search

Navigation