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
- Decreased efficacy of oesophageal antireflux mechanisms particularly LOS tone
- 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
- Dysphagia
- Stricture or Barrett oesophagus can develop as a result of long standing reflux