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| Reflux Esophagitis |
| Etiology • By definition, reflux esophagitis is caused by increased contact with gastric acid through reflux • However, more factors than simple reflux are involved (see pathogenesis) |
| Pathogenesis • Multifactorial including components of the following events: • Decreased competency of the lower esophageal sphincter(LES) which may be due to: transient LES relaxation(most common mechanism); anatomic abnormalities of the LES such as sliding hiatus hernia: intrinsic hypotonality of the LES muscle • Decreased or inadequate mucosal mechanisms such as: slowed esophageal acid clearance; decreased esophageal HCO3 secretion; insufficient H ion clearance pump intramucosally, |
| Epidemiology • In the U.S, 7% of the population have daily and 15% monthly evidence of GERD • 50-70% of pregnant women have evidence of GERD • 50-75% of people with GERD have documented esophagitis equaling 3-4% of the general population • Older people have a slightly higher incidence of esophagitis • GERD is equally prevalent in males and females but esophagitis shows an increased incidence in males, 2-3:1 |
| General Gross Description •Unless removed for some other reason, large esophageal specimens with reflux esophagitis are not seen •The endoscopic appearance of reflux esophagitis uncomplicated by ulceration, Barrett's esophagus or stricture may be relatively normal or may show erythema. |
| General Microscopic Description •The most reproducible and earliest finding is the presence of eosinophils and/or neutrophils •There may be hyperplasia of the basal epithelial zone which normally occupies a maximum of 10-15% of the thickness of the epithelium •Hyperplasia of the basal zone is accompanied by thickening of the epithelium with increase in the height of the vascular papillae of the laminar propria to greater than 50% of the thickness of the epithelium •The histologic complications of reflux such as ulceration and stricture are described separately |
| Clinical Correlation •The most common cause of esophagitis is gastroesophageal reflux •Of people with gastroesophageal reflux disease (GERD) 50-70% will develop esophagitis (histologically proven) •The most common symptoms of GERD are heartburn (>50%), dysphagia (>30%) and regurgitation •The major complications are Barrett's epithelium (15%), peptic stricture (15%) and significant GI bleeding (2%) |
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 761-762 • Sleisenger MH, Fordtran JS. Gastrointestinal disease. 5th ed. Philadelphia: Saunders, 1993, pp. 378-401 |
| Reflux Esophagitis |
| Synopsis by: Martin Nadel M.D. (T62000M41000)[200] |
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