Gastro-Oesophageal Reflux Disease, Ulcerations & Strictures, oh my!

GORD!!! Can you believe it?! GORD!!!
Enough of that.

Gastro-duodenal contents can enter the lower oesophagus, just for the hell of it, and a small amount of reflux, as it is known, can be perfectly normal. When abnormal reflux causes oesophagitis, however, this is known as Gastro-Oesophageal Reflux Disease.
Only a % of these actually have symptoms, though.

Symptoms:
Dysphagia

Regurgitation

Nocturnal asthma

Aetiology
Increased abdominal pressure

(pregnancy/obesity/trauma/vomiting)
Lower oesophageal sphincter incompetence
(smoking/alcohol/hiatus hernia/systemic sclerosis)
Decreased muscosal protection
(NSAIDs)

Ix
Endoscopy
 - normal/erythema
Biopsy +/- Barium Swallow

Histology
NB there is a poor correlation between symptom severity and the actual histological findings.
There are 3 diagnostic histological features in biopsies:

1. Epithelial Hyperplasia
2. Congestion of the lamina propria
3. Chronic inflammatory cells within muscosa

Neutrophils are suggestive of ulceration

Complications

• Mucosal erosions
• Ulceration
• Lower oesophageal stricture
• Bleeding
• Barrett's Oesophagus

Erosive & Ulcerative Oesophagitis
Well visualised at endoscopy.
Similar to those found in PUD.


Benign Strictures
Occur when recurrent/persistent ulceration leads to oesophageal fibrosis
These can be focal/circumferential = stenosis & dysphagia

Tx
Underlying causes/Sx