Upper GI Tract Pathology

Question 1

What are the pathological mechanisms associated with GORD?

Answer 1

GORD:

Oesophageal reflux occurs when the oesophageal sphincter has stopped working, caused by a hiatus hernia.

Gastric acid from stomach refluxes up into oesophagus

The gastric acid damages the cells, leading to erosion and inflammation.

This results in the squamous epithelium thickening

If ulceration occurs (extreme reflux) then the healing process can produce a benign oesophageal stricture. A stricture in the oesophagus results in impaired motility and obstruction of bolus.

Question 2

What are the pathological mechanisms associated with Barrett’s Oesophagus

Answer 2

Barrett’s Oesophagus

• Prolonged GORD results in Barrett’s Oesophagus
• Under Endoscopy, Barrett’s Oesophagus has a silky appearance
• Normal squamous epithelium changes to columnar epithelium (it can withstand acid better than normal squamous)

Question 3

What are the pathological mechanisms associated with Peptic Ulcers?

Answer 3

Peptic Ulcers

A localised defect extending down into the submucosa (at least) as a result of an acid and pepsin attack

Pathology of peptic ulceration:

H. Pylori - increases gastric acid volume

NSAIDS

Delayed gastric emptying