Oesophagitis and Barrett's oesophagus Flashcards
What types of oesophagitis are there?
Acute (rare)
Chronic (common)
What are the two possible causes of acute oesophagitis?
- The spread of bacterial infection from the nasopharynx to involve the oesophagus:
Herpes simplex type 1, Cytomegalovirus, Candida albicans
Particularly seen in immunocomprimised patients after chemotherapy, immunosuppressed patients after transplant, or patients with AIDS.
Candidiasis is also seen in patients with diabetes or on antibiotic therapy. - Ingestion of corrosive substances
What are the two types of chronic oesophagitis?
Specific or non-specific
What is non-specific chronic oesophagitis?
It is very common
It usually results from reflux oesophagitis
What causes specific chronic oesophagitis?
TB and Crohn’s disease.
Although it is very rare.
What is reflux oesophagitis?
Inflammation of the oesophagus due to refluxed low pH gastric content.
List some potential causes of reflux oesophagitis?
Defective sphincter mechanism Hiatus hernia Increased gastric fluid volume Inefficient luminal clearance Abnormal oesophageal motility Increased intra-abdominal pressure (in pregnancy)
What percentage of the Western population is affected by GORD?
35%
When is GORD diagnosed?
It is diagnosed when there are clinical symptoms, endoscopic lesions or histopathological alterations attributable to gastro-oesophogeal reflux
Is there a correlation between symptoms and oesophagitis?
There is a poor correlation.
E.g, some patients have severe symptoms but little or no damage to their oesophageal lining
while some patients are asymptomatic but have obvious inflammation on endoscopy
What is a hiatus hernia?
When part of the stomach herniates in to the chest cavity.
There are two types: sliding and rolling
Sliding: gastro-oesophageal junction slides up into the chest, and in many cases the lower oesophageal sphincter becomes incompetent.
Rolling: The gastro-oesophageal junction remains inthe abdomen, but a bulge of stomach herniates up into the chest alongside the oesophagus.
What lifestyle factors are potential risk factors for GORD?
Smoking Alcohol Obesity Hot beverages Caffeine Patient age and gender
What happens to the cells lining the oesophagus in GORD?
Exposure of the squamous mucosa to refluxed acids leads to cell injury, accelerated desquamation (shedding of the epithelial layer), erosion and inflammation.
What is the result of the increased cell loss?
There is hyperplasia of the squamous epithelium with elongated subepithelial connective tissue papillae, thickened basal cell layer and less mature cells occupying most of the epithelial thickness.
What sort of response accompanies the epithelial injury?
An inflammatory cell response. This varies from small numbers of polymorphs including eosinophils and neutrophils, as well as lymphocytes, to the formation of granulation tissue with many acute inflammatory cells and fibrinous exudate if ulceration occurs.
This heals by epithelial regeneration and underlying fibrosis.
