REFLUX OESOPHAGITIS
DEFINITIONS
Barrett's oesophagus
As a consequence of acid reflux
Presence of intestinal metaplastic COLUMNAR epithelium which has replaced SQUAMOUS epithelium
Reflux oesophagitis
May b asymptomatic
Produced by persistant episodes of reflux
Inflammation of the lower oesophagus
Gastro-oesophageal reflux disease (GORD)
Patient with reflux who has persistant symptoms
Gastro-oesophageal reflux
Can occur normally with no symptoms
Reflux of gastric contents
RF's
Rx for achalasia
Retention of food bolus wth increasing obstruction & dilatation
Failure of relaxation at the sphincter
Contractility of lower oesophagus = lost
Systemic sclerosis
Fibrosis & atrophy of the smooth muscle - dysphagia
Drugs
Nitrates
Calcium channel blockers
Anti-cholinergic
Smoking
Large meals
Hiatus hernia
ROLLING: rarer: a part of the greater curvature of stomach rolls thru a defect in the diaphragm
SLIDING: stomach & gastroesophageal junction slip up into chest so that junction is above diapragm
More common with age due to muscle weakening
More common in men
Defect in diaphragm - portion of stomach passes thru diaphragmatic opening (the oesophageal hiatus) into chest cavity
Extreme physical exertion
Coughing
Constrictive clothing
Bending; straining
Obesity
Pregnancy (hormonal changes)
Ascites
Food & drink: relax lower oesophageal sphincter
Fat
Chocolate
Coffee
Alcohol
Symptoms
Dysphagia
Aspiration & regurgitation
Causing cough & nocturnal asthma
Regurgitation
Resting lower oesophageal sphincter fails to increase
especially on bending/lying flat
of food & 'acid' into mouth
RetroSTERNAL/SubSTERNAL chest pain
usually after meals/at bedtime
Heartburn (PYroSIS)
?accompanied by regurgitation/vomiting
aggrevated by reclining, belching & increased abdominal pressure
occuring 1-4 hrs after eating
Signs
Stricture
Shrinkage of fibrous tissue can produce a segmental narrowing
Healing of ulcer = achievied by fibrosis
Ulceration can occur
haemorrhage/even perforation
Aspiration into lungs
producing pneumonia
Bleeding
due to oesophagits
Iron-deficiency anaemia
Haematemesis
