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Reflux esophagitis (GERD) (Clinical picture of GERD (Dysphagia.,…
Reflux esophagitis (GERD)
Reflux of gastric contents into
the lower esophagus
the most important cause
of esophagitis
Clinical picture of GERD
Dysphagia.
Regurgitation + sour tasting
Recurrent heartburn (dominant symptom)
Rarely, chest pain
Age: usually adults > 40
Contributory factors
Decreased efficacy
of anti-reflux mechanisms
Alcohol or tobacco exposure
Prolonged gastric
intubation
ICU patient
CNS depressants
In most cases, no obvious etiology
Sliding hiatal hernia
Inadequate clearance of
refluxed material
Delayed gastric emptying
Increased gastric volume
GROSS APPEARANCE
depend on
The causative agent.
The duration & severity of the
exposure
Severe esophagitis
ulceration into the
submucosa
Epithelial
erosions
Mild esophagitis
Simple hyperemia
MICROSCOPIC
APPEARANCE
Three characteristic
Basal zone hyperplasia
Elongation of lamina propria papillae with congested capillaries
Eosinophils with or without neutrophils, in the epithelial layer
Intraepithelial neutrophils are markers of severity and severity of symptoms is
not closely related to the degree of histologic picture
Complications
Development of
stricture (narrowing)
chronic inflammation >>
fibrosis >> stricture
Barrett esophagus
Ulceration:
Bleeding.
increased risk of adenocarcinoma