A4.

Esophagitis forms

• ESOPHAGITIS → injury to the esophageal mucosa with subsequent inflammation

 Inflammation of the Esophagus
 Can be acute or chronic.
 Symptoms
 Heartburn (dominant symptom)
 Odynophagia (painful swallowing)
 Dysphagia (difficulty in swallowing)
• Etiology
 Reflux of gastric acid → GERD due to incompetence of the LES (very common)
 Prolonged gastric intubation
 Ingestion of irritants (alcohol, corrosive acids or alkalis, smoking)
 Uraemia (Illness accompanying kidney failure)
 Infections in patients with leukemia, lymphoma, AIDS (immunocompromised
 viruses like HSV, CMV and also fungi, like candida)
• Gastroesophageal Reflex Disorder (GERD)
 Gastric content regurgitates.
 Affects 0.5% of the US adult population.
 Many causes
 LES tone decreases
 Drugs
 Hypothyroidism
 Gravidity
 Alcohol, smoking
 Hiatal Hernia
 Morphology
 Erosion, inflammation, reactive epithelial proliferation, Ulcer, bleeding, scarring and Barrett
 Barrett esophagus, or columnar epithelium lined lower oesophagus (CELLO) refers to an
abnormal change, or metaplasia, in the cells of the inferior portion of the esophagus.
 It is an acquired precancerous lesion.
 The normal squamous epithelium lining of the esophagus is replaced by metaplastic columnar
and goblet cells.
 This pattern of epithelium is normally found in the lower part of the GI system (Only the
presence of goblet cells equates a diagnosis of Barrett esophagus)
 Barrett esophagus is strongly associated with esophageal adenocarcinoma, a particular lethal
cancer.
 Complications of reflex esophagitis
 Mucosal injury = severe acute inflammation, necrosis and ulceration with the formation of
granulation tissue (eventual fibrosis of stenosis)
 Long-standing GE reflex = replacement of distal squamous mucosa by metaplastic gastric or
intestinal epithelium: Barrett’s Oesophagus – Result
 Peptic ulcer may develop + dysplasia that can contribute to adenocarcinoma