REFLUX OESOPHAGITIS

Haematemesis

Iron-deficiency anaemia

Bleeding

due to oesophagits

Aspiration into lungs

producing pneumonia

Stricture

Ulceration can occur

haemorrhage/even perforation

Healing of ulcer = achievied by fibrosis

Shrinkage of fibrous tissue can produce a segmental narrowing

Heartburn (PYroSIS)

occuring 1-4 hrs after eating

aggrevated by reclining, belching & increased abdominal pressure

?accompanied by regurgitation/vomiting

RetroSTERNAL/SubSTERNAL chest pain

usually after meals/at bedtime

Regurgitation

of food & 'acid' into mouth

especially on bending/lying flat

Resting lower oesophageal sphincter fails to increase

Aspiration & regurgitation

Causing cough & nocturnal asthma

Dysphagia

Food & drink: relax lower oesophageal sphincter

Alcohol

Coffee

Chocolate

Fat

Ascites

Pregnancy (hormonal changes)

Obesity

Bending; straining

Constrictive clothing

Coughing

Extreme physical exertion

Hiatus hernia

Defect in diaphragm - portion of stomach passes thru diaphragmatic opening (the oesophageal hiatus) into chest cavity

More common in men

More common with age due to muscle weakening

SLIDING: stomach & gastroesophageal junction slip up into chest so that junction is above diapragm

ROLLING: rarer: a part of the greater curvature of stomach rolls thru a defect in the diaphragm

Large meals

Smoking

Drugs

Anti-cholinergic

Calcium channel blockers

Nitrates

Systemic sclerosis

Fibrosis & atrophy of the smooth muscle - dysphagia

Rx for achalasia

Contractility of lower oesophagus = lost

Failure of relaxation at the sphincter

Retention of food bolus wth increasing obstruction & dilatation

Gastro-oesophageal reflux

Reflux of gastric contents

Can occur normally with no symptoms

Gastro-oesophageal reflux disease (GORD)

Patient with reflux who has persistant symptoms

Reflux oesophagitis

Inflammation of the lower oesophagus

Produced by persistant episodes of reflux

May b asymptomatic

Barrett's oesophagus

Presence of intestinal metaplastic COLUMNAR epithelium which has replaced SQUAMOUS epithelium

As a consequence of acid reflux