Vertical lines in distal esophageal mucosa (VLEM): A true endoscopic manifestation of esophagitis in children?

Background: We observed an endoscopic abnormality in a group of children with histological esophagitis. We termed this finding ''vertical lines in esophageal mucosa'' (VLEM). We examined the relationship between the presence of VLEM and significant histologic changes in esophageal mucosal biopsies. Methods: Between January 1, 1992, and August 31, 1994, the senior author (JFF) performed 255 esophageal biopsies. The procedure reports, available endoscopic photographs, and histology reports were reviewed to establish the endoscopic and histologic appearance of the esophageal mucosa. Intraepithelial cells were counted in a blind review of 42 randomly selected biopsies. Results: The esophageal mucosa had a normal appearance on 160 endoscopic studies (Group 1)and VLEM were the only mucosal abnormalities in 41 endoscopies (Group 2). Histology was normal in 92 of 160 biopsies (57.5%) from Group 1, and 1 of 41 biopsies (2.4%) from Group 2. Most patients in Group 2 had eosinophilic esophagitis (34 of 41, 83%, specificity 0.85, sensitivity 0.5, p < 0.001) which was of moderate to severe intensity(31 of 34, 91.2%, specificity 0.88, sensitivity 0.73, p < 0.081). Conclusions: Histology usually demonstrated moderate to severe inflammation when VLEM were present. VLEM may be a highly specific endoscopic feature of esophagitis in children.