Reflux Esophagitis

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Reflux esophagitis refers to the gross or histological inflammatory changes that occur in the esophageal mucosa in response to reflux. The clinical picture is characterized by retro-sternal or epigastric pain, heartburn, and dysphagia that periodically recur. Periods of remission with very mild clinical symptoms are followed by acute exacerbations. In many cases the complaints progress over time, eventually leading to complications such as chronic ulcers, scarring, strictures, columnar metaplasia, and adenocarcinoma.

Table 3.2 Pathophysiology of reflux disease

Incompetent antireflux mechanisms

► Persistent increased transient relaxation of the LES

► Hypotensive LES

► Shortened LES

► Hiatal hernia

Impaired esophageal clearance

► Motility disorders (scleroderma)

Impaired gastric emptying

Volume and corrosiveness of the refluxate

Fig. 3.22 Gastroesophageal reflux

Fig. 3.22 Gastroesophageal reflux

Complaints. A wide variety of complaints is possible, ranging from mild postprandial discomfort, which the patient may not even consider abnormal, to severe complaints like those seen in reflux esophagitis (Table 3.3).

Table 3.3 Symptoms of reflux disease

Typical

Atypical

► Epigastric pain

► Vomiting

► Heartburn

► Chest pain

► Regurgitation

► Cough, "chronic bronchitis"

► Odynophagia

► Hoarseness

► Dysphagia

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