Prevalence and Histological Features of the Gastric Cardia-type Mucosa in Children

BACKGROUND: It has been suggested that the presence of gastric cardia in adults (with or without inflammation or intestinal cells) is a metaplastic condition. The presence of gastric cardia in children would argue against this contention. We examined the presence and determinants of gastric cardia-type mucosa at a normally located z-line in children without underlying gastroesophageal reflux disease (GERD)-predisposing disorders. METHODS: We conducted a prospective study of consecutive pediatric patients undergoing routine upper endoscopy. We excluded patients with coagulopathy or bleeding disorder, prior gastric or esophageal surgery, major congenital disorders, or neurodevelopmental disorders. Biopsies were obtained with the endoscope in the anterograde position within 5 mm below the endoscopic z-line, and were examined for the presence of gastric cardia-type mucosa, defined as both mucous and oxynto-mucous glands. RESULTS: Eighteen (47%) of 38 subjects has gastric cardia mucosa. There were no significant differences in age, gender, or race between patients with and without gastric cardia-type mucosa. There were no differences between the groups in weight and height either at birth or at the time of endoscopy, in the mother's age at childbirth or history of peripartum problems. There were no differences in symptoms suggestive of reflux such as spitting up or difficulty of gaining weight. Neither history of gastroesophageal testing nor histological esophagitis (38% versus 40%) was different between the groups with and without gastric cardia-type mucosa. CONCLUSIONS: Gastric cardia-type mucosa is unlikely to be a metaplastic condition since it is present in a large proportion of children undergoing endoscopy. Neither histological esophagitis nor GERD symptoms are significantly associated with the presence of gastric cardia-type mucosa.