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Gastroesophageal reflux disease (view source)
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'''Gastroesophageal reflux disease''', abbreviated '''GERD''', is a common pathology of the [[esophagus]]. It is also known as '''reflux esophagitis'''. | |||
It is occasionally abbreviated ''GORD'' (gastro-oesophageal reflux disease). | |||
==General== | |||
Clinical: | |||
*Usually chest pain | |||
*+/-Abdominal pain. | |||
*+/-Vomiting. | |||
*+/-Blood loss. | |||
Treatment: | |||
*Treated with [[proton pump inhibitor]]s (PPIs). | |||
DDx (clinical): | |||
*[[Eosinophilic esophagitis]]. | |||
==Gross== | |||
*Erythema. | |||
*Erosions. | |||
*+/-Ulceration. | |||
Note: | |||
*Many be graded using ''Savary-Miller classification''. | |||
Images: | |||
*[http://www.gastrohep.com/images/image.asp?id=171 Savary-Miller classification - endoscopic images (gastrohep.com)]. | |||
==Microscopic== | |||
Features: | |||
#[[Basal cell hyperplasia]];<ref name=pmid16707971>{{Cite journal | last1 = Steiner | first1 = SJ. | last2 = Kernek | first2 = KM. | last3 = Fitzgerald | first3 = JF. | title = Severity of basal cell hyperplasia differs in reflux versus eosinophilic esophagitis. | journal = J Pediatr Gastroenterol Nutr | volume = 42 | issue = 5 | pages = 506-9 | month = May | year = 2006 | doi = 10.1097/01.mpg.0000221906.06899.1b | PMID = 16707971 }}</ref> > 3 cells thick ''or'' >15% of epithelial thickness. | |||
#Papillae elongated; papillae reach into the top 1/3 of the epithelial layer.<ref name=Ref_PBoD804>{{Ref PBoD|804}}</ref> | |||
#Inflammation, esp. eosinophils, lymphocytes with convoluted nuclei ("squiggle cells"). | |||
#+/-Intraepithelial edema. | |||
#+/-Apoptotic cells.<ref name=pmid9926792>{{cite journal |author=Wetscher GJ, Schwelberger H, Unger A, ''et al.'' |title=Reflux-induced apoptosis of the esophageal mucosa is inhibited in Barrett's epithelium |journal=Am. J. Surg. |volume=176 |issue=6 |pages=569–73 |year=1998 |month=December |pmid=9926792 |doi= |url=}}</ref> | |||
Notes: | |||
*Intraepithelial cells with irregular nuclear contours, "squiggle cells" (T lymphocytes<ref name=pmid7587806>{{Cite journal | last1 = Cucchiara | first1 = S. | last2 = D'Armiento | first2 = F. | last3 = Alfieri | first3 = E. | last4 = Insabato | first4 = L. | last5 = Minella | first5 = R. | last6 = De Magistris | first6 = TM. | last7 = Scoppa | first7 = A. | title = Intraepithelial cells with irregular nuclear contours as a marker of esophagitis in children with gastroesophageal reflux disease. | journal = Dig Dis Sci | volume = 40 | issue = 11 | pages = 2305-11 | month = Nov | year = 1995 | doi = | PMID = 7587806 }}</ref>), may mimic [[neutrophil]]s. | |||
*Changes may be focal. | |||
*[[PPI effect]] may be seen in a concurrent [[stomach|gastric]] biopsy. | |||
DDx: | |||
*[[Eosinophilic esophagitis]] - characterized by similar histomorphologic features. The key difference is: more [[eosinophil]]s. | |||
*[[Barrett's esophagus]] - intestinal metaplasia may be minimal. | |||
Images: | |||
*[http://www.archivesofpathology.org/action/showFullPopup?id=i1543-2165-134-6-815-f03&doi=10.1043%2F1543-2165-134.6.815 EE versus GERD (archivesofpathology.org)].<ref name=pmid20524860>{{Cite journal | last1 = Genevay | first1 = M. | last2 = Rubbia-Brandt | first2 = L. | last3 = Rougemont | first3 = AL. | title = Do eosinophil numbers differentiate eosinophilic esophagitis from gastroesophageal reflux disease? | journal = Arch Pathol Lab Med | volume = 134 | issue = 6 | pages = 815-25 | month = Jun | year = 2010 | doi = 10.1043/1543-2165-134.6.815 | PMID = 20524860 }}</ref> | |||
==Sign out== | |||
===Poorly oriented=== | |||
<pre> | |||
ESOPHAGUS, BIOPSY: | |||
- SQUAMOUS MUCOSA WITH BASAL CELL HYPERPLASIA, INTRAEPITHELIAL EDEMA AND RARE INTRAEPITHELIAL | |||
EOSINOPHILS -- COMPATIBLE WITH GASTROESOPHAGEAL REFLUX. | |||
</pre> | |||
===Columnar epithelium present=== | |||
<pre> | |||
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. | |||
</pre> | |||
===Ulceration present=== | |||
<pre> | |||
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. | |||
</pre> | |||
===BE and GERD present=== | |||
<pre> | |||
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. | |||
</pre> | |||
==See also== | |||
*[[Esophagus]]. | |||
*[[Barrett's esophagus]]. | |||
*[[PPI effect]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Esophagus]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||