Definition
Most gastroenterologists define it as the passage of gastric contents reflux into the oesophagus and symptoms associated with it.
Incidence
It is thought that between one third and half of adults suffer from intermittent heartburn and about 10% every day.
Endoscopic aspects of gastro-oesophageal reflux disease
In approximately 20% of patients with symptoms of reflux, the oesophagus endoscopically can be completely normal. Many traders believe that certain deficiencies distal oesophageal endoscopy are not sufficiently specific and related oesophageal reflux. However, the endoscopic grading of esophagitis, which is most commonly used by operators, is to Savary-Miller already codified in 1977:
- Grade 1: one or more erosions arising on friable mucosa, erythematous, oedematous;
- Grade 2: confluent erosions that do not occupy the entire circumference of the lumen of the oesophagus;
- Grado3 erosion occupying the entire circumference of the oesophagus;
- Grade 4: chronic wounds, ulcers, strictures, Barrett’s oesophagus
Complications associated with reflux
Stenosis
In approximately 15% of patients with esophagitis develop stenosis. The presenting symptom is usually dysphagia, initially for solids, but gradually also for liquids, which gradually narrows the lumen. The stenosis occurs when the inflammation circumferential oesophageal wall extends to the sub mucosa with subsequent fibrous reaction that leads to the formation of scar tissue, with shortening and narrowing of the oesophageal lumen. The initial therapy of stenosis is to treat the underlying reflux esophagitis. Some operators think that we should expand all the strictures on a guide wire or a balloon.
Ulcers
Oesophageal ulcers are rare, usually are the result of sclerotherapy of oesophageal varices, but may also be associated with reflux esophagitis and Barrett’s metaplasia. Endoscopic examination revealed deep lesions, based on off-white, usually in the distal oesophagus that can be biopsied.
You can assign stenosis or mucosal damage from reflux. It may be noted that occasionally bleeding can be massive.
Barrett’s metaplasia
In patients with chronic reflux esophagitis normal squamous oesophageal mucosa can be replaced by a columnar epithelium meta plastic epithelium. The current theory is that chronic reflux esophagitis causes chronic inflammation of the mucous membrane peeling skin and is gradually replaced by columnar epithelium. As this change occurs, the squamocolumnar junction migrates cephalad and can be found at the upper third of the oesophagus However, the segment of Barrett’s metaplasia may be short, extending only 2-3 cm into the oesophagus
There are three types of columnar epithelium:
1. fundic mucosa, identical to that found in the gastric fundus;
2. cardia-type mucosa with glands and surface epithelial pilorocardiali foveola;
3. specialized mucosa of Barrett meta plastic epithelium of the type or intestinal type.
It is believed that the latter mucosa meta plastic epithelium is the tissue on which they develop dysplasia and cancer. Segment Barrett’s oesophagus is devoid of folds, sometimes you see the submucosal blood vessels and has a salmon pink appearance. Barrett’s metaplasia is a precancerous lesion. In about 8% of patients with Barrett’s metaplasia develops after an adenocarcinoma. Therefore, it is necessary to control endoscopy with biopsy. Segment Barrett’s should practice Bx every 2 cm on all four quadrants at each height, and also samples of any visible abnormality endoscopically.