Difference between revisions of "Gastroesophageal reflux disease"
Jump to navigation
Jump to search
| Line 1: | Line 1: | ||
'''Gastroesophageal reflux disease''', abbreviated '''GERD''', is a common pathology of the [[esophagus]]. It is | '''Gastroesophageal reflux disease''', abbreviated '''GERD''', is a common pathology of the [[esophagus]]. It is occasionally abbreviated ''GORD'' (gastro-oesophageal reflux disease). | ||
'''Reflux esophagitis''' redirects here. It technically isn't a synonym.<ref>{{Cite journal | last1 = Orbelo | first1 = DM. | last2 = Enders | first2 = FT. | last3 = Romero | first3 = Y. | last4 = Francis | first4 = DL. | last5 = Achem | first5 = SR. | last6 = Dabade | first6 = TS. | last7 = Crowell | first7 = MD. | last8 = Geno | first8 = DM. | last9 = Dejesus | first9 = RS. | title = Once-Daily Omeprazole/Sodium Bicarbonate Heals Severe Refractory Reflux Esophagitis with Morning or Nighttime Dosing. | journal = Dig Dis Sci | volume = | issue = | pages = | month = Jan | year = 2014 | doi = 10.1007/s10620-013-3017-y | PMID = 24448652 }}</ref><ref>{{Cite journal | last1 = Karbasi | first1 = A. | last2 = Ardestani | first2 = ME. | last3 = Ghanei | first3 = M. | last4 = Harandi | first4 = AA. | title = The association between reflux esophagitis and airway hyper-reactivity in patients with gastro-esophageal reflux. | journal = J Res Med Sci | volume = 18 | issue = 6 | pages = 473-6 | month = Jun | year = 2013 | doi = | PMID = 24250694 }}</ref> | |||
==General== | ==General== | ||
Revision as of 18:38, 31 January 2014
Gastroesophageal reflux disease, abbreviated GERD, is a common pathology of the esophagus. It is occasionally abbreviated GORD (gastro-oesophageal reflux disease).
Reflux esophagitis redirects here. It technically isn't a synonym.[1][2]
General
Clinical:
- Usually chest pain
- +/-Abdominal pain.
- +/-Vomiting.
- +/-Blood loss.
Treatment:
- Treated with proton pump inhibitors (PPIs).
DDx (clinical):
Gross
- Erythema.
- Erosions.
- +/-Ulceration.
Note:
- Many be graded using Savary-Miller classification.
Images:
Microscopic
Features:
- Basal cell hyperplasia;[3] > 3 cells thick or >15% of epithelial thickness.
- Papillae elongated; papillae reach into the top 1/3 of the epithelial layer.[4]
- Inflammation, esp. eosinophils, lymphocytes with convoluted nuclei ("squiggle cells").
- +/-Intraepithelial edema.
- +/-Apoptotic cells.[5]
Notes:
- Intraepithelial cells with irregular nuclear contours, "squiggle cells" (T lymphocytes[6]), may mimic neutrophils.
- Changes may be focal.
- PPI effect may be seen in a concurrent gastric biopsy.
- Perinuclear clearing may be seen.[7]
DDx:
- Eosinophilic esophagitis - characterized by similar histomorphologic features. The key difference is: more eosinophils.
- Barrett's esophagus - intestinal metaplasia may be minimal.
Images:
Sign out
Poorly oriented
ESOPHAGUS, BIOPSY: - SQUAMOUS MUCOSA WITH BASAL CELL HYPERPLASIA, INTRAEPITHELIAL EDEMA AND RARE INTRAEPITHELIAL EOSINOPHILS -- COMPATIBLE WITH GASTROESOPHAGEAL REFLUX.
Columnar epithelium present
ESOPHAGUS, BIOPSY: - SQUAMOUS MUCOSA WITH BASAL CELL HYPERPLASIA, INTRAEPITHELIAL EDEMA AND RARE INTRAEPITHELIAL EOSINOPHILS -- COMPATIBLE WITH GASTROESOPHAGEAL REFLUX. - COLUMNAR EPITHELIUM WITH MODERATE CHRONIC INACTIVE INFLAMMATION. - NEGATIVE FOR INTESTINAL METAPLASIA. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
Ulceration present
ESOPHAGUS, DISTAL, BIOPSY: - SQUAMOUS MUCOSA WITH BASAL CELL HYPERPLASIA, INTRAEPITHELIAL EDEMA, RARE INTRAEPITHELIAL EOSINOPHILS AND EVIDENCE OF ULCERATION -- COMPATIBLE WITH GASTROESOPHAGEAL REFLUX. - COLUMNAR EPITHELIUM WITH MODERATE CHRONIC INACTIVE INFLAMMATION. - NEGATIVE FOR INTESTINAL METAPLASIA. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. COMMENT: PAS-D staining is negative for microorganisms.
BE and GERD present
ESOPHAGUS (DISTAL), BIOPSY: - COLUMNAR EPITHELIUM WITH INTESTINAL METAPLASIA AND MODERATE CHRONIC INFLAMMATION, SEE COMMENT. - SQUAMOUS MUCOSA WITH BASAL CELL HYPERPLASIA, INTRAEPITHELIAL EDEMA AND RARE INTRAEPITHELIAL EOSINOPHILS -- COMPATIBLE WITH GASTROESOPHAGEAL REFLUX. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. COMMENT: The findings are consistent with Barrett's esophagus in the appropriate endoscopic setting.
See also
References
- ↑ Orbelo, DM.; Enders, FT.; Romero, Y.; Francis, DL.; Achem, SR.; Dabade, TS.; Crowell, MD.; Geno, DM. et al. (Jan 2014). "Once-Daily Omeprazole/Sodium Bicarbonate Heals Severe Refractory Reflux Esophagitis with Morning or Nighttime Dosing.". Dig Dis Sci. doi:10.1007/s10620-013-3017-y. PMID 24448652.
- ↑ Karbasi, A.; Ardestani, ME.; Ghanei, M.; Harandi, AA. (Jun 2013). "The association between reflux esophagitis and airway hyper-reactivity in patients with gastro-esophageal reflux.". J Res Med Sci 18 (6): 473-6. PMID 24250694.
- ↑ Steiner, SJ.; Kernek, KM.; Fitzgerald, JF. (May 2006). "Severity of basal cell hyperplasia differs in reflux versus eosinophilic esophagitis.". J Pediatr Gastroenterol Nutr 42 (5): 506-9. doi:10.1097/01.mpg.0000221906.06899.1b. PMID 16707971.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 804. ISBN 0-7216-0187-1.
- ↑ Wetscher GJ, Schwelberger H, Unger A, et al. (December 1998). "Reflux-induced apoptosis of the esophageal mucosa is inhibited in Barrett's epithelium". Am. J. Surg. 176 (6): 569–73. PMID 9926792.
- ↑ Cucchiara, S.; D'Armiento, F.; Alfieri, E.; Insabato, L.; Minella, R.; De Magistris, TM.; Scoppa, A. (Nov 1995). "Intraepithelial cells with irregular nuclear contours as a marker of esophagitis in children with gastroesophageal reflux disease.". Dig Dis Sci 40 (11): 2305-11. PMID 7587806.
- ↑ URL: http://155.37.5.42/eAtlas/GI/1262.htm. Accessed on: 31 January 2014.
- ↑ Genevay, M.; Rubbia-Brandt, L.; Rougemont, AL. (Jun 2010). "Do eosinophil numbers differentiate eosinophilic esophagitis from gastroesophageal reflux disease?". Arch Pathol Lab Med 134 (6): 815-25. doi:10.1043/1543-2165-134.6.815. PMID 20524860.