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

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.