Complications of GORD

Oesophagitis

Reflux oesophagitis is a chronic inflammatory process mediated by gastric acid and pepsin from the stomach as well as bile from the duodenum, which can result in ulceration of the mucosa and secondary fibrosis in the muscular wall. A range of endoscopic findings, from mild redness to severe bleeding ulceration with stricture formation, is recognised. There is a poor correlation between symptoms and histological and endoscopic findings. A normal endoscopy and normal oesophageal histology are perfectly compatible with significant gastro-oesophageal reflux disease. Plate 2 shows an endoscopic view of mild oesophagitis.

Other causes of oesophagitis: infectious diseases

Viruses, bacteria, fungi and mycobacterium can all cause oesophageal infection. The most common of these are candida. Oesophageal candidiasis occurs in debilitated patients and those taking broad-spectrum antibiotics or cytotoxic drugs. It is a particular problem in AIDS patients, who are also susceptible to a spectrum of oesophageal infections. Oesophageal candidiasis rarely develops in patients who do not have an underlying disease such as diabetes, immune deficiency or malignancy. The main symptoms of oesophageal candidiasis are dysphagia and odynophagia. Severe infection of the gullet can destroy oesopha-geal innervation, causing abnormal motility.

Corrosives

Accidental or suicidal ingestion of highly alkaline or acidic substances may result in injury to the oesophagus. The most common symptom is odynophagia, but patients may also complain of dysphagia and chest pain. Ingestion of caustic compounds is followed by painful burns of the mouth and pharynx and by extensive erosive oesophagitis. At the time of presentation, management is conservative, based upon analgesia and nutritional support. Vomiting should be avoided and endoscopy should not be done at this stage because of the high risk of oesophageal perforation. Following the acute phase, a barium swallow and X-ray examination is performed to demonstrate the extent of stricture formation. Endoscopic dilation is usually necessary, although it is difficult and hazardous because strictures are often long, tortuous and easily perforated.

Barrett's oesophagus

Barrett's oesophagus is defined as epithelial metaplasia in which the normal squamous epithelium of the oesophagus is replaced by one or more of the following types of columnar epithelium: a specialised columnar epithelium, a junctional type of epithelium; and/or a gastric type of epithelium. Barrett's oesophagus is thought to be a consequence of chronic gastro-oesophageal reflux.

Diagnosis of Barrett's oesophagus is made by endoscopic visualisation of the oesophageal mucosa, supported by examination of tissue biopsies. Barrett's oesophagus is recognised endoscopically as confluent areas or fingers of pink, gastric-like mucosa extending from the cardia of the stomach into the oesophagus. The prevalence of adenocarcinoma in patients with Barrett's oesophagus is reported to be in the region of 30 to 50 times that of the general population (Clark et al. 2000). Consequently patients discovered to have Barrett's changes during endoscopy are considered for endoscopic surveillance programmes. Patients with moderate dysplasia should undergo repeated biopsies at 6 to 12-monthly intervals. Patients found to have severe dysplasia usually have associated cancer and are usually referred for oesophageal surgery.

Anaemia

Iron deficiency anaemia occurs as a consequence of chronic, insiduous blood loss and can result from longstanding oesophagitis.

Benign oesophageal stricture

An oesophageal stricture is an abnormal formation of fibrous tissue that is usually at the lower end of the oesophagus. Fibrous strictures develop as a consequence of longstanding oesophagitis. Most patients are older and have poor oesophageal peristaltic activity. Progressive dysphagia is the most common clinical feature. Diagnosis is made by endoscopy and biopsies of the stricture are taken to exclude malignancy. Treatment of strictures may involve the use of weighted bougies, pneumatic balloon dilators or graduated plastic Savary-Gillard dilators. An endoscopic balloon dilation of a benign oesophageal stricture is shown in Plate 3.

Subsequent treatment usually involves long-term therapy with a proton pump inhibitor drug (i.e. omeprazole or lansoprazole) which should be prescribed to reduce the risk of recurrent oesophagitis and stricture formation. The patient should be advised to chew food thoroughly and it is also important to ensure that dentition is adequate.

How To Get Rid Of Yeast Infections Once And For All

How To Get Rid Of Yeast Infections Once And For All

No more itching, odor or pain or your money is refunded! Safe and DRUG FREE Natural Yeast Infection Solutions Are you looking for a safe, fast and permanent cure for your chronic yeast infection? Get Rid of that Yeast Infection Right Now and For Good!

Get My Free Ebook


Post a comment