Reflux oesophagitis

Reflux oesophagitis, also known as GERD (Gastroesophageal Reflux Disease), is inflammation caused by regurgitation of the acid contents of the stomach into the esophagus. A mild degree of reflux experienced episodically (say after a large meal) is a normal physiological condition and reflux is only a problem when it causes symptoms or other medical disease.

Reflux can cause:

• Discomfort (heartburn)

Less commonly and in more severe cases:

• Regurgitation (vomit-like taste in the mouth)
• Strictures or scarring of oesophagus (especially young children).
• Barrett Oesophagus (sometimes referred to as Barrett's Disease) or dysplasia (a pre-cancerous condition).

In the adult, oesophagitis causes discomfort which is treated with antacids or some medications such as H² receptor antagonists (such as ranitidine, or famotidine) or proton pump inhibitors (such as omeprazole, or pantoprozole). Monitoring and assessment of patients with reflux is often performed via Gastroscopy / Endoscopy which involves the insertion of a thin optical scope into the oesophagus and stomach (while the patient is sedated) in order to assess the state of the oesaphagus and stomach.

Biopsies can be peformed during gastroscopy and these may show:

• Oedema and basal hyperplasia (non-specific inflammatory changes)
• Lymphocytic inflammation (non-specific)
• Neutrophilic inflammation (usually either reflux or Helicobacter gastritis)
• Eosinophilic inflammation (usually reflux)
• Goblet cell intestinal metaplasia or Barretts oesophagus.
• Dysplasia or pre-cancer.
• Carcinoma.

Barrett's Oesophagus has been regarded as a precursor condition to dysplasia which is in turn is a precursor conditoin for carcinoma. The risk of progression from Barretts to dysplasia is uncertain but is estimated to include 5% - 10% of cases, and has probably been exaggerated in the past.