Reflux oesophagitis

• Most important cause of oesophagitis
• Contributing factors include;
  • Decreased efficacy of oesophageal antireflux mechanisms particularly LOS tone
  • Presence of a sliding hiatal hernia
  • Inadequate of slowed oesophageal clearance of refluxed material
  • Reduced reparative capacity of the oesophageal mucosa
• In most instances there is more than one cause
• The action of gastric acids  is critical to the development of oesophageal injury

 

Morphology

• Hyperaemia and oedema
• Thickened basal zone (exceeding 20% of the epithelium)
• Neutrophil and eosinophil infiltration
• Elongation of the lamina propria papillae with capillary congestion, extending into the top 1/3 of the epithelial layer
• Superficial necrosis and ulceration with adjacent inflammatory exudates

 

Clinical

• Most commonly affects adults
• Symptoms are;
  • Dysphagia
  • Heartburn
  • Regurgitation of gastric contents into the mouth
  • Haematemesis
  • Melena
• Stricture or Barrett oesophagus can develop as a result of long standing reflux