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Difference between revisions of "Gastroesophageal reflux disease"
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Gastroesophageal reflux disease (view source)
Revision as of 19:27, 14 April 2016
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Gastroesophageal reflux disease -- intermed mag.jpg | |||
| Width = | |||
| Caption = [[Micrograph]] showing histology compatible with gastroesophageal reflux disease. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = basal cell hyperplasia (> 3 cells thick or >15% of epithelial thickness), papillae elongated (papillae reach into the top 1/3 of the epithelial layer), inflammation, esp. eosinophils, lymphocytes with convoluted nuclei ("squiggle cells"), +/-intraepithelial edema, +/-apoptotic cells, +/-glycogenation | |||
| Subtypes = | |||
| LMDDx = intestinal metaplasia ([[Barrett's esophagus]]), [[eosinophilic esophagitis]], [[acute esophagitis]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[esophagus]] | |||
| Assdx = [[obesity]], [[Barrett's esophagus]] | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = common | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = erythema, erosions, +/-ulceration. | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = [[eosinophilic esophagitis]], [[acute esophagitis]] | |||
| Tx = proton pump inhibitors | |||
}} | |||
'''Gastroesophageal reflux disease''', abbreviated '''GERD''', is a common pathology of the [[esophagus]]. It is occasionally abbreviated ''GORD'' (gastro-oesophageal reflux disease). | '''Gastroesophageal reflux disease''', abbreviated '''GERD''', is a common pathology of the [[esophagus]]. It is occasionally abbreviated ''GORD'' (gastro-oesophageal reflux disease). | ||
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Note: | Note: | ||
*Many be graded using ''Savary-Miller classification''. | *Many be graded using ''Savary-Miller classification'' or ''Los Angeles classification''.<ref name=pmid20659145>{{Cite journal | last1 = Genta | first1 = RM. | last2 = Spechler | first2 = SJ. | last3 = Kielhorn | first3 = AF. | title = The Los Angeles and Savary-Miller systems for grading esophagitis: utilization and correlation with histology. | journal = Dis Esophagus | volume = 24 | issue = 1 | pages = 10-7 | month = Jan | year = 2011 | doi = 10.1111/j.1442-2050.2010.01092.x | PMID = 20659145 }}</ref> | ||
Images: | Images: | ||
*[http://www.gastrohep.com/images/image.asp?id=171 Savary-Miller classification - endoscopic images (gastrohep.com)]. | *[http://www.gastrohep.com/images/image.asp?id=171 Savary-Miller classification - endoscopic images (gastrohep.com)]. | ||
===Los Angeles classification for GERD=== | |||
Features:<ref>URL: [http://www.sciencedirect.com/science/article/pii/S2212097113700463 http://www.sciencedirect.com/science/article/pii/S2212097113700463]. Accessed on: 14 April 2015</ref> | |||
{| class="wikitable sortable" | |||
! Classification | |||
! Description | |||
|- | |||
| A | |||
| mucosal break <=5 mm, not beyond the tops of two (adjacent) mucosal folds | |||
|- | |||
| B | |||
| mucosal break >5 mm, not beyond the tops of two (adjacent) mucosal folds | |||
|- | |||
| C | |||
| mucosa break beyond the tops of two mucosal folds but <75% of the esophageal circumference | |||
|- | |||
| D | |||
| mucosal break >=75% of the esophageal circumference | |||
|- | |||
|} | |||
Note: | |||
*Correlation with histology is poor; mucosal breaks are seen rarely.<ref name=pmid20659145>{{Cite journal | last1 = Genta | first1 = RM. | last2 = Spechler | first2 = SJ. | last3 = Kielhorn | first3 = AF. | title = The Los Angeles and Savary-Miller systems for grading esophagitis: utilization and correlation with histology. | journal = Dis Esophagus | volume = 24 | issue = 1 | pages = 10-7 | month = Jan | year = 2011 | doi = 10.1111/j.1442-2050.2010.01092.x | PMID = 20659145 }}</ref> | |||
==Microscopic== | ==Microscopic== | ||
| Line 34: | Line 87: | ||
#+/-Intraepithelial edema. | #+/-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> | #+/-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> | ||
#+/-Glycogen - cytoplasm cleared (white).<ref name=pmid8409304>{{cite journal |author=Vadva MD, Triadafilopoulos G |title=Glycogenic acanthosis of the esophagus and gastroesophageal reflux |journal=J. Clin. Gastroenterol. |volume=17 |issue=1 |pages=79–83 |year=1993 |month=July |pmid=8409304 |doi= |url=}}</ref> | |||
Notes: | Notes: | ||
| Line 45: | Line 99: | ||
*[[Barrett's esophagus]] - intestinal metaplasia may be minimal. | *[[Barrett's esophagus]] - intestinal metaplasia may be minimal. | ||
Images: | ===Images=== | ||
<gallery> | |||
Image: Gastroesophageal reflux disease -- low mag.jpg | GERD - low mag. | |||
Image: Gastroesophageal reflux disease -- intermed mag.jpg | GERD - intermed. mag. | |||
Image: Gastroesophageal reflux disease -- high mag.jpg | GERD - high mag. | |||
Image: Gastroesophageal reflux disease - glycogen -- intermed mag.jpg | GERD - intermed. mag. | |||
Image: Gastroesophageal reflux disease - glycogen -- high mag.jpg | GERD - high mag. | |||
Image: Gastroesophageal reflux disease - glycogen -- very high mag.jpg | GERD - high mag. | |||
</gallery> | |||
www: | |||
*[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> | *[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> | ||
==Stains== | |||
*[[Oil red O stain]] +ve in macrophages from [[bronchoalveolar lavage]] specimens.<ref name=pmid20466562>{{Cite journal | last1 = Hopkins | first1 = PM. | last2 = Kermeen | first2 = F. | last3 = Duhig | first3 = E. | last4 = Fletcher | first4 = L. | last5 = Gradwell | first5 = J. | last6 = Whitfield | first6 = L. | last7 = Godinez | first7 = C. | last8 = Musk | first8 = M. | last9 = Chambers | first9 = D. | title = Oil red O stain of alveolar macrophages is an effective screening test for gastroesophageal reflux disease in lung transplant recipients. | journal = J Heart Lung Transplant | volume = 29 | issue = 8 | pages = 859-64 | month = Aug | year = 2010 | doi = 10.1016/j.healun.2010.03.015 | PMID = 20466562 }}</ref> | |||
==Sign out== | ==Sign out== | ||
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*[[Barrett's esophagus]]. | *[[Barrett's esophagus]]. | ||
*[[PPI effect]]. | *[[PPI effect]]. | ||
*[[Glycogenic acanthosis of the esophagus]]. | |||
==References== | ==References== | ||