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| Ulcer | ||||||||
| Etiology •Esophageal ulcers are most commonly caused by necrotizing esophagitis •Multiple etiologies exist for irritation of the esophageal mucosa causing microscopic and clinical esophagitis •The most frequent are: peptic irritation (gastroesophageal reflux disease (GERD) or nonGERD); infectious (viral, fungal or bacterial); toxic (chemical); cytotoxic chemotherapy; irritants (alcohol, smoking, hot fluids and foodstuffs) | ||||||||
| Pathogenesis •Ulceration results from necrosis of the mucosa and submucosa with necrosis of the surface epithelium alone traditionally being called erosion •The distinction between erosion and ulceration is one of depth and not of etiology •Any condition causing mucosal necrosis can lead to ulceration, and it is a very common occurrence in most cases of symptomatic esophagitis •In the U.S. peptic irritation is the major cause and this involves exposure of epithelium to the caustic effect of acid •An increasingly common occurrence is fungal or less commonly viral superinfection in an immunocompromised host either due to primary immunodeficiency or secondary to chemotherapy Epidemiology | •Great variation in incidence exists geographically ranging from estimates of 5-10% in the U.S. to 80% in Iran •In the U.S. the primary cause is gastroesophageal reflux(GERD) while in France it is alcohol consumption and in Iran and the far east dietary General Gross Description | •Ulcers are punched out defects in the mucosa and underlying tissue •Their base is filled with necrotic tissue debris and exudate •The margins are often raised, smooth with some reddening and edema •The marginal tissue is usually soft in contrast to malignant ulcers which have very firm edges •The ulcers may exhibit evidence of hemorrhage General Microscopic Description | •The base of an ulcer is filled with necrotic debris, and acute inflammation •As time goes on, granulation tissue may be seen, as well as chronic inflammation and underlying fibrosis •Vascular congestion and hemorrhage can be seen Clinical Correlation | •Symptoms are those of the underlyng condition but a sudden increase in pain may accompany ulcer formation •Hemorrhage may occur •Therapy is directed towards the primary disease References | •The best discussions are to be found under the primary disease Ulcer
| Synopsis by: Martin Nadel M.D. (T62000M38000)[378]
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