Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-27T12:43:48.333Z Has data issue: false hasContentIssue false

Chapter 11 - Infections of the Oesophagus and Rare Forms of Oesophagitis

Published online by Cambridge University Press:  06 June 2020

By
Shaun V. Walsh
Edited by
Roger M. Feakins
Roger M. Feakins
Affiliation:
Royal Free London NHS Foundation Trust, London, UK
Get access

Summary

Gastro-oesophageal reflux disease (GORD) is a condition that develops as a result of retrograde flow (reflux) of gastro-duodenal contents into the oesophagus, with or without mucosal tissue damage. The main symptoms include heartburn without a specific frequency or duration. Histological mucosal changes include mild basal cell hyperplasia, scattered intraepithelial eosinophils, dilated intracellular spaces, and lamina propria papillae reaching the upper one-third of the squamous epithelium. Other histological findings that can be present in the setting of GORD are balloon cells, keratinocyte vacuolization, intraepithelial lymphocytosis, vascular lakes, and parakeratosis. Ulceration can also occur if GORD is severe. Barrett’s oesophagus (BO) is an acquired condition defined by endoscopically visible metaplastic columnar epithelium more than 1 cm above the gastro-oesophageal junction (GOJ) with biopsy confirmation of columnar metaplasia. Presence or absence of intestinal metaplasia (IM) should be documented as it harbours an increased risk of progression to oesophageal adenocarcinoma (OAC). The risk of progression of BO to OAC increases if there is dysplasia in addition to columnar metaplasia. Endoscopic examination in conjunction with histopathological evaluation and documentation of presence or absence of dysplasia is the current recommended method of surveillance.

Keywords

gastro-oesophageal reflux disease (GORD)Barrett’s oesophagus (BO)dysplasialow-grade dysplasiahigh-grade dysplasiaindefinite for dysplasiaoesophageal adenocarcinomasquamous dysplasia
Type
Chapter
Information
Non-Neoplastic Pathology of the Gastrointestinal Tract
A Practical Guide to Biopsy Diagnosis
 , pp. 169 - 178
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Yassin, TM, Toner, PG. Langerhans cells in the human oesophagus. J Anat. 1976;122:435–45.Google ScholarPubMed
Di Pilato, V, Freschi, G, Ringressi, MN, Pallecchi, L, Rossolini, GM, Bechi, P. The oesophageal microbiota in health and disease. Ann N Y Acad Sci. 2016;1381(1):21–33.CrossRefGoogle ScholarPubMed
Paterson, AL, Lao-Sirieix, P, O’Donovan, M, et al., BEST and BEST 2 study groups. Range of pathologies diagnosed using a minimally invasive capsule sponge to evaluate patients with reflux symptoms. Histopathology. 2017;70(2):203–10.Google Scholar
Zimmerman, D, Criblez, DH, Evan, DS, et al. Acute herpes simplex viral esophagitis occurring in 5 immunocompetent individuals with eosinophilic esophagitis. ACG Case Rep J. 2016;3(3):165–8.Google Scholar
Monsanto, P, Almeida, N, Cipriano, MA, et al. Concomitant herpetic and eosinophilic esophagitis–a causality dilemma. Acta Gastroenterol Belg. 2012;75(3):361–3.Google ScholarPubMed
Gill, RA, Gebhard, RL, Dozeman, RL, Sumner, HW. Shingles esophagitis: endoscopic diagnosis in two patients. Gastrointest Endosc. 1984;30(1):26–7.CrossRefGoogle ScholarPubMed
Hummel, M, Abecassis, MM. A model for reactivation of CMV from latency. J Clin Virol. 2002;25(Suppl 2):S123–36.CrossRefGoogle Scholar
Bartelsman, JF, Lange, JM, van Leeuwen, R, van den Tweel, JG, Tytgat, GN. Acute primary HIV-esophagitis. Endoscopy. 1990;22(4):184–5.Google Scholar
Chawla, SK, Ramani, K, Chawla, K, LoPresti, P, Mahadevia, P. Giant esophageal ulcers of AIDS: ultrastructural study. Am J Gastroenterol. 1994;89(3):411–15.Google ScholarPubMed
Salaria, SN, Abu Alfa, AK, Cruise, MW, et al. Lichenoid esophagitis: clinicopathologic overlap with established esophageal lichen planus. Am J Surg Pathol. 2013;37(12):1889–94.CrossRefGoogle ScholarPubMed
Odze, R, Antonioli, D, Shocket, D, Noble-Topham, S, Goldman, H, Upton, M. Esophageal squamous papillomas: a clinicopathologic study of 38 lesions and analysis for human papillomavirus by the polymerase chain reaction. Am J Surg Pathol. 1993;17(8):803–12.CrossRefGoogle ScholarPubMed
Vasapolli, R, Malfertheiner, P, Kandaluski, A. Helicobacter pylori and non-malignant upper gastrointestinal diseases. Helicobacter 2016;21(Suppl 1):30–3.Google Scholar
Kumar, S, Minz, M, Sinha, SK, et al. Esophageal tuberculosis with coexisting opportunistic infections in a renal allograft transplant recipient. Transpl Infect Dis. 2017;19(1):e12640.CrossRefGoogle Scholar
Abdalla, J, Myers, J, Moorman, J. Actinomycotic infection of the oesophagus. J Infect. 2005;51(2):E39–E43.CrossRefGoogle ScholarPubMed
Valour, F, Sénéchal, A, Dupieux, C, et al. Actinomycosis: etiology, clinical features, diagnosis, treatment, and management. Infect Drug Resist. 2014;7: 183–97.Google Scholar
Alioglu, B, Avci, Z, Canan, O, et al. Invasive esophageal aspergillosis associated with acute myelogenous leukemia: successful therapy with combination caspofungin and liposomal amphotericin B. Pediatr Hematol Oncol. 2007;24(1):63–8.Google Scholar
Jacobs, DH, Macher, AM, Handler, R, Bennett, JE, Collen, MJ, Gallin, JI. Esophageal cryptococcosis in a patient with the hyperimmunoglobulin E-recurrent infection (Job’s) syndrome. Gastroenterology. 1984;87(1):201–3.CrossRefGoogle Scholar
Margolis, PS, Epstein, A. Mucormycosis esophagitis in a patient with the acquired immunodeficiency syndrome. Am J Gastroenterol. 1994;89(10):1900–2.Google Scholar
Miller, DP, Everett, ED. Gastrointestinal histoplasmosis. J Clin Gastroenterol. 1979;1(3):233–6.Google Scholar
Khandekar, A, Moser, D, Fidler, WJ. Blastomycosis of the esophagus. Ann Thorac Surg. 1980;30(1):76–9.Google Scholar
Cardillo, F, de Pinho, RT, Antas, PR, et al. Immunity and immune modulation in Trypanosoma cruzi infection. Pathog Dis. 2015;73(9)ftv 082 (Abstract).Google Scholar
Atias, A, Neghme, A, Aguirre Mackay, L, Jarpa, S. Megaesophagus, megacolon, and Changes’ disease in Chile. Gastroenterology. 1963;44:433–7.Google Scholar
Dellon, ES, Gonsalves, N, Hirano, I, Furuta, GT, Liacouras, CA, Katzka, DA; American College of Gastroenterology. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013;108(5):679–92.Google Scholar
Papadopoulou, A, Koletzko, S, Heuschkel, R, et al. Management guidelines of eosinophilic esophagitis in childhood. J Pediatr Gastroenterol Nutr. 2014;58(1):107–18.CrossRefGoogle ScholarPubMed
Wolf, WA, Cotton, CC, Green, DJ, et al. Evaluation of histologic cutpoints for treatment response in eosinophilic esophagitis. J Gastroenterol Hepatol Res. 2015;4(10):1780–7.Google Scholar
Reed, C, Woosley, JT, Dellon, ES. Clinical characteristics, treatment outcomes, and resource utilization in children and adults with eosinophilic gastroenteritis. Dig Liver Dis. 2015;47(3):197–201.Google Scholar
Attwood, SE, Wilson, MS. Current hurdles in the management of eosinophilic oesophagitis: the next steps. World J Gastroenterol. 2013;19(6):790–6. DOI:10.3748/wjg.v19.i6.790.Google Scholar
Straumann, A.Eosinophillic esophagitis: indications for treatment. Dig Dis. 2014;32(1–2):110–13.Google Scholar
Attwood, SE, Smyrk, TC, Demeester, TR, Jones, JB. Esophageal eosinophilia with dysphagia: a distinct clinicopathologic syndrome. Dig Dis Sci. 1993;38(1):109–16.CrossRefGoogle ScholarPubMed
Kelly, KJ, Lazenby, AJ, Rowe, PC, Yardley, JH, Perman, JA, Sampson, HA. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology. 1995;109(5):1503–12.Google Scholar
Lee, RG. Marked eosinophilia in esophageal mucosal biopsies. Am J Surg Pathol. 1985;9(7):475–9.Google Scholar
Dellon, ES. Eosinophilic esophagitis. Gastroenterol Clin North Am. 2013;42(1):133–53.Google Scholar
Walsh, SV, Antonioli, DA, Goldman, H, et al. Allergic esophagitis in children: a clinicopathological entity. Am J Surg Pathol. 1999;23(4):390–6.Google Scholar
Sonnenberg, A, Dellon, ES, Turner, KO, Genta, RM. The influence of Helicobacter pylori on the ethnic distribution of esophageal eosinophilia. Helicobacter. 2016;22(3). DOI:10.1111.Google ScholarPubMed
Rothenberg, ME. Molecular, genetic, and cellular bases for treating eosinophilic esophagitis. Gastroenterology. 2015;148(6):1143–57.Google Scholar
Kindel, SJ, Joy, BF, Pahl, E, Wald, EL. Eosinophilic esophagitis in children following cardiac transplantation: association with post-transplant lymphoproliferative disorder and other transplant outcomes. Pediatr Transplant. 2014;18(5):491–6.CrossRefGoogle ScholarPubMed
Safroneeva, E, Straumann, A, Coslovsky, M, et al. Symptoms have modest accuracy in detecting endoscopic and histologic remission in adults with eosinophilic esophagitis. Gastroenterology. 2016;150(3):581–90.Google Scholar
Hirano, I, Moy, N, Heckman, MG, Thomas, CS, Gonsalves, N, Achem, SR. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut. 2013;62(4):489–95.Google Scholar
Mueller, S, Neureiter, D, Aigner, T, Stolte, M. Comparison of histological parameters for the diagnosis of eosinophilic oesophagitis versus gastro-oesophageal reflux disease on oesophageal biopsy material. Histopathology. 2008;53(6):676–84.Google Scholar
Dellon, ES, Speck, O, Woodward, K, et al. Distribution and variability of esophageal eosinophilia in patients undergoing upper endoscopy. Mod Pathol. 2015;28(3):383–90.Google Scholar
Molina-Infante, J, Bredenoord, AJ, Cheng, E, et al. Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis. Gut. 2016;65(3):524–31.Google Scholar
Pasricha, S, Gupta, A, Reed, CC, et al. Lymphocytic esophagitis: an emerging clinicopathologic disease associated with dysphagia. Dig Dis Sci. 2016;61(10):2935–41.Google Scholar
Rubio, CA, Sjödahl, K, Lagergren, J. Lymphocytic esophagitis: a histologic subset of chronic esophagitis. Am J Clin Pathol. 2006;125(3):432–7.Google Scholar
Purdy, JK, Appelman, HD, Golembeski, CP, McKenna, BJ. Lymphocytic esophagitis: a chronic or recurring pattern of esophagitis resembling allergic contact dermatitis. Am J Clin Pathol. 2008;130(4):508–13.Google Scholar
Rubio, CA, Ichiya, T, Schmidt, PT. Lymphocytic oesophagitis, eosinophilic oesophagitis and compound lymphocytic-eosinophilic oesophagitis I: histological and immunohistochemical findings. J Clin Pathol. 2016;pii: jclinpath–2016–203782.Google Scholar
Ebach, DR, Vanderheyden, AD, Ellison, JM, Jensen, CS. Lymphocytic esophagitis: a possible manifestation of pediatric upper gastrointestinal Crohn’s disease. Inflamm Bowel Dis. 2011;17(1):45–9.Google Scholar
Xue, Y, Suriawinata, A, Liu, X, et al. Lymphocytic esophagitis with CD4 T-cell-predominant intraepithelial lymphocytes and primary esophageal motility abnormalities: a potential novel clinicopathologic entity. Am J Surg Pathol. 2015;39(11):1558–67.Google Scholar
Putra, J, Muller, KE, Hussain, ZH, et al. Lymphocytic esophagitis in nonachalasia primary esophageal motility disorders: improved criteria, prevalence, strength of association, and natural history. Am J Surg Pathol. 2016;40(12):1679–85.CrossRefGoogle ScholarPubMed
Moawad, FJ, Appleman, HD. Sloughing esophagitis: a spectacular histologic and endoscopic disease without a uniform clinical correlation. Ann N Y Acad Sci. 2016;1380(1):178–82.Google Scholar
Hart, PA, Romano, RC, Moreira, RK, Ravi, K, Sweetser, S. Esophagitis dissecans superficialis: clinical, endoscopic, and histologic features. Dig Dis Sci. 2015;60(7):2049–57.Google Scholar
Purdy, JK, Appelman, HD, McKenna, BJ. Sloughing esophagitis is associated with chronic debilitation and medications that injure the esophageal mucosa. Mod Pathol. 2012;25(5):767–75.CrossRefGoogle ScholarPubMed
Carmack, SW, Vemulapalli, R, Spechler, SJ, Genta, RM. Esophagitis dissecans superficialis (‘sloughing esophagitis’): a clinicopathologic study of 12 cases. Am J Surg Pathol. 2009;33(12):1789–94.Google Scholar
Chandan, VS, Murray, JA, Abraham, SC. Esophageal lichen planus. Arch Pathol Lab Med. 2008;132(6):1026–9.Google Scholar
Abraham, SC, Ravich, WJ, Anhalt, GJ, Yardley, JH, Wu, TT. Esophageal lichen planus: case report and review of the literature. Am J Surg Pathol. 2000;24(12):1678–82.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×