Reflux esophagitis

by Jason Wasserman MD PhD FRCPC
April 19, 2022

What is reflux esophagitis?

Reflux esophagitis is a medical condition associated with damage and inflammation on the inside of the esophagus. Another name for this condition is gastroesophageal reflux disease (GERD).

What are the symptoms of reflux esophagitis?

Patients with reflux esophagitis may experience chest pain, difficulty swallowing food, and a burning sensation in the throat or chest. The symptoms are often worse shortly after a meal or when lying down.

What causes reflux esophagitis?

Reflux esophagitis is caused by the movement or ‘reflux’ of acid from the stomach into the esophagus. For many people with this condition, certain foods act as a trigger and avoiding these foods often offers significant relief. Alcohol also acts as a trigger for reflux.

Patients with diabetes, hypothyroidism, abdominal obesity, and certain autoimmune disorders are also at increased risk of developing reflux esophagitis. The condition is also much more common in pregnant women as the growing uterus puts upward pressure on the stomach.

How do pathologists make the diagnosis of reflux esophagitis?

In order to make a diagnosis of reflux esophagitis, tissue samples must be taken from the inside of the esophagus. These tissue samples are called biopsies. Your doctor will use a camera device called an endoscope to examine the inside of your esophagus and perform the biopsies. This is a brief procedure that may cause some discomfort but is not painful. Your pathologist then examines the tissue samples under a microscope.

The biopsies are usually taken from the end of the esophagus, where the esophagus meets the stomach.  Pathologists use the term “distal” to describe the end of the esophagus and the area where the esophagus and the stomach meet is called the gastroesophageal junction.

What does reflux esophagitis look like under the microscope?

When examined under the microscope, tissue samples from a person with reflux esophagitis will show a large number of specialized immune cells within the epithelium that covers the inside of the esophagus. These cells include neutrophils, eosinophils, and plasma cells. The cells that sit at the very bottom of the epithelium may also be increased in number. These cells are called basal cells and pathologists describe this change as basal cell hyperplasia. In severe disease, the squamous cells in the epithelium are lost. Pathologists describe this change as an erosion and some pathology reports will use the term “erosive esophagitis” instead of reflux esophagitis when making this diagnosis.

What can happen if reflux esophagitis is not treated?

If the acid reflux continues over a long period of time (usually years), the squamous cells that line the inside of the esophagus are replaced by cells that are normally found in the small intestine. These intestinal cells are designed to protect tissue from the strong acids in the stomach. The change from squamous cells to intestinal-type is called intestinal metaplasia.

When intestinal metaplasia happens in the esophagus it is given the special name Barrett’s esophagus. Barret’s esophagus is a non-cancerous disease. However, it is considered a pre-cancerous condition because it is associated with an increased risk of developing a type of cancer in the esophagus called adenocarcinoma.