Esophagus

Question 1

Five criteria for GERD

Answer 1

1. Thickened basal layer (>15% or 5-6 layers)
2. Increased papillary length (to >50% mucosal thickness)
3. Intraepithelial eosinophils, neutrophils (>1-2 cells/40x field)
4. Intraepithelial mononuclear cells (>10/40x field)
5. Dilated/widened intercellular spaces

Question 2

Esophageal lichen planus

Answer 2

Present in 30-50% of LP cases, or may be the sole manifestation. Cause of dysphagia and recurrent strictures, like GERD.

In the esophagus, characterized by parakeratosis, acanthosis OR thinning, band-like lymphocytic inflammation, Civatte bodies (dyskeratotic keratinocytes, shown). Intraepithelial eosinophils are usually absent, in contrast to GERD.

DDx includes irritation by gold, thiazides, antimalarials.

Question 3

Pityriasis lichenoides family

Answer 3

Family of dermatoses including:
* Pityriasis lichenoides chronica
* Pityriasis lichenoides et varioliformis acuta
* Febrile ulceronecrotic Mucha-Habermann disease

Can very rarely affect the esophagus, but this diagnosis is impossible without dermatologic correlation.

Question 4

When there is concern for pemphigus/pemphigoid disease of the esophagus, you have to. . .

Answer 4

. . . submit part of the specimen fresh for immunofluorescence.

Question 5

Pemphigus vulgaris

Answer 5

The most common form of pemphigus, and basically ALWAYS involves oral mucosa.

Esophageal involement is usually present, but often subclinical.

Question 6

HSV esophagitis

Answer 6

EGD with “volcano” ulcer.

Infection resides within the epithelium, with prominent mononuclear infiltrate adjacent to the infected epithelium.

Question 7

CMV esophagitis

Answer 7

EGD with “linear” ulceration.

Infection resides within stromal cells at the ulcer base.

Question 8

Crohn’s esophagitis (esophageal Crohn’s disease)

Answer 8

Tricky diagnosis to make, you basically need to see an epithelioid granuloma in a patient with known Crohn’s in order to call it.

Question 9

“Lymphocytic esophagitis”

Answer 9

Describes a pattern of injury more than an actual disease.

May be attributed to:
* GERD
* Gastritis
* Celiac disease
* Carcinoma of the esophagus
* Hiatal hernia
* Peptic ulcer disease
* Hashimoto’s thyroiditis
* Cirrhosis
* Crohn’s disease

Question 10

Amyloidosis-associated pseudoachalasia

Answer 10

Systemic amyloidoses can result in amyloid deposition within LES-innervating nerves or the esophageal wall itself.

Both of these can result in increased resting LES tone, causing a syndrome identical to that of achalasia.