Difference between revisions of "Esophagus"

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Esophagus (view source)

Revision as of 18:22, 31 January 2014

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→‎Gastroesophageal reflux disease: split out
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==Gastroesophageal reflux disease==
==Gastroesophageal reflux disease==
*Abbreviated ''GERD'' or ''GORD'' (gastro-oesophageal reflux disease).
*Abbreviated ''GERD'' or ''GORD'' (gastro-oesophageal reflux disease).
===General===
*[[AKA]] ''reflux esophagitis''.
Clinical:
{{Main|Gastroesophageal reflux disease}}
*Usually chest pain
*+/-Abdominal pain.
*+/-Vomiting.
*+/-Blood loss.
 
Treatment:
*Treated with proton pump inhibitors (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>


==Eosinophilic esophagitis==
==Eosinophilic esophagitis==
Michael
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