REFLUX OESOPHAGITIS

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