Your diagnosis

Reflux esophagitis

This article will help you read and understand your pathology report for reflux esophagitis.

by Jason Wasserman, MD PhD FRCPC, updated March 14, 2021

Quick facts:

  • Reflux esophagitis is a medical condition associated with damage and inflammation of the epithelium on the inside of the esophagus.
  • Reflux esophagitis is caused by the movement or ‘reflux’ of acid from the stomach into the esophagus.

The esophagus

The esophagus is a long hollow tube that starts at the back of your throat and ends at the top of your stomach. When you swallow food or liquids they travel down the esophagus into the stomach. The inner surface of the esophagus is lined with specialized squamous cells that form a barrier to protect the inside of the esophagus. This thin tissue barrier is called the epithelium.

normal esophagus histology

What is reflux esophagitis?

Reflux esophagitis is a medical condition associated with damage and inflammation of the epithelium on the inside of the esophagus. Another name for this condition is gastroesophageal reflux disease (GERD). Patients with reflux esophagitis may experience chest pain, difficultly swallowing food, and a burning sensation in the throat or chest. The symptoms are often worse shortly after a meal or when lying down.

How do pathologists make this diagnosis?

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 to 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.

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. 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 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.

Long term complications of reflux esophagitis

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 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 epithelium to intestinal epithelium is an example of intestinal metaplasia.

When intestinal metaplasia happens in the esophagus it is given the special name Barretts 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.

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