Esophagitis:
Reflux of gastric contents is the
major cause of reflux esophagitis. Many factors play role:
(a) the presence of a sliding hiatal hernia is the most common;
(b) heavy alcohol use;
(c) heavy tobacco use;
(d) increased gastric volume;
(e) decreased efficacy of
LES;
(f) pregnancy;
(g) CNS depressants;
(h) hypothyroidism.
Although largely limited to adults older than 40 years of age, reflux esophagitis is occasionally seen in infants and children.
What are other causes of esophagitis?
• Ingestion of
irritants (eg, alcohol, corrosive acids);
•
infections in immunosuppressed hosts by fungi (eg, Candida) or viruses (eg, CMV, herpes);
•
uremia;
•
radiation therapy;
•
graft-versus-host disease;
• and
cytotoxic anticancer therapy.
Endoscopically, the esophageal mucosa shows erythema and prominent vascular markings, hemorrhage, and ulcers.
What are the major complications of reflux esophagitis?
The potential complications of
severe reflux esophagitis are
(a) ulcer;
(b) bleeding;
(c) development of stricture;
(d) development of Barrett esophagus.
In Barrett esophagitis, the
squamous mucosa is replaced by metaplastic
columnar epithelium as a response to
prolonged reflux-induced injury in the lower part of the esophagus.
About
10% of patients who have a
Barrett esophagus will develop
adenocarcinoma of the esophagus. Most, if not all, of these carcinomas are preceded by the
metaplasia-dysplasia-cancer sequence.
Most adenocarcinomas arising in a Barrett esophagus occur in
white males older than
40 years of age. Patients usually present because of
dysphagia, weight loss, bleeding, chest pain, and vomiting. Heaped-up margins around a lesion are usually a
sign of tumor invasion into adjacent tissue.
Most adenocarcinomas arising in Barrett esophagus are
advanced at the time of diagnosis. The prognosis of advanced esophageal adenocarcinoma is
poor, as it has a less than
20% overall 5-year survival rate. What factors predispose to esophageal squamous cell carcinoma?
The most important factors are
• smoking and alcohol consumption.
• Other factors include fungal contamination of food;
• dietary nitrites;
• dietary deficiencies (vitamins A, C, and riboflavin);
• and longstanding esophagitis.
What is the usual location of esophageal squamous cell carcinomas?
20% occur in the upper third,
50% in the middle third, and 30% in the lower third of the esophagus.
Linear Mode
