Pathologic Basis of Esophageal Disease Flashcards
Esophagitis
Inflammation and injury of esophageal mucosa
-5% of US adults
Etiology of Esophagitis:
Chemical injury
- reflux of gastric contents
- acids, alkalis, alc, tobacco
- meds
Infection
- fungal (Candida)
- viral (herpes simplex virus)
Immune related disease
- eosinophilic esophagitis
- derm diseases (lichen planus)
- Radiation
- Trauma
Reflux esophagitis
- inj/inflamm from reflux of gastric contents
- leads to GERD
- Clinical features:
- heartburn, regurgitation
- atypical: angina like pain, hoarse, asthma, hiccups
- or asx
Prognosis/therapy:
- depends on degree of LES pressure
- early detection prevents complications
- untreated: ulcerations, strictures, Barrett’s, adenocarcinoma
Tx:
lifestyle mods, PPI, surg if severe (Nissen fundoplication)
What does herpetic vs candida esophagitis look like?
herpetic:
punched out ulcers
viral inclusions on histology
candida:
white plaques
fungus on histology
Eosinophilic esophagitis
-caused by allergic and immunologic factors, frequently COEXISTS with allergic diseases
Clinical features
- vomiting, pain, dyspepsia, progressing to odynophagia and stenosis
- assoc w/ food allergies and atopic sx
Prognosis/ther:
- best if dx early
- severe esophageal strictures if confused with reflux
- when strictures occur, dilatation is indicated
- elimination of food allergens and swallowing of corticosteroids =tx
What does EoE look like?
RINGED esophagus
linear furrows
on histology: many eosinophils
Functional esophageal obstruction
- Nutcracker esophagus
- Diffuse esophageal spasm
- Hypertensive LES
- Achalasia
Structural Esophageal obstruction
- diverticula
- esophageal mucosal webs/rings
- congenital abnormalities
- benign esophageal stenosis
- tumors
Diverticula (acquired structural esophageal obstruction)
Zenkers:
- uppermost portion of the esophagus
- regurgitation, halitosis, and aspiration (clinical: gurgling)
- assoc w/ reduced UES compliance
Mid esophagus:
-usually asx, assoc w/ mediastinal inflammation (ie TB)
Epiphrenic:
-symptomatic, secondary to coexistence with hiatal hernia
Esophageal webs and rings
(structural obstruction)
- acquired
- Clinically: resp for 5-15% of dysphagia or choking sensation
- More common in females >40 y
- most asx
- common: dysphagia, odynophagia
- UES webs assoc w/ Plummer Vinson syndrome
Gross: mucosal folds or indentations; 2 cell layers thick
Ddx: post inflammatory stenosis (reflux, lye)
Thickness of Schatzki ring
3 cell layers
Esophageal atresia and tracheoesophageal fistula
- congenital
- failure of foregut to divide into trachea and esophagus during 4th week of devel.
Clinical features:
- food regurgitation, drooling, aspiration
- H shape TEF may be diagnosed later in older kids w/ repeated bouts of pneumonia
Congenital esophageal stenosis
-narrowing of mid esophagus
esophageal webs/rings
muscular hypertrophy
inflammation
Motility disorders
(functional esophageal obstruction)
-diseases affecting normal coordination of swallowing
General:
- repetitive high amplitude non peristaltic contractions (diffuse esophageal spasm: ganglionitis; hypertrophy of inner muscle layer)
- peristaltic high amplitude peristalsis (Nutcracker esophagus: extensive hypertrophy of inner muscle layer)
- Diffuse esophageal spasms (Corkscrew esophagus)
- Aperistalsis, lack of LES relaxation and increase IRP (Achalasia (chronic ganglionitis with myenteric plexus destruction))
- Decreased muscular activity (muscular dystrophies, scleroderma, Chagas, Amyloidosis)
Esophageal Lacerations
Mallory-Weiss tears
Boerhaave syndrome
-severe retching or vomiting, often associated with alcohol intoxication
