Reflux

-Acid or Alkaline

AllergicIatrogenic

-Pill induced or NG tube

Infectious

Esophagitis

Reflux Disease

Clinical: Heartburn

Endoscopic: Erythema, red streaks, ulcers

Histologic: Squamous hyperplasia, inflammation (eos, pmns)

Physiologic: 24-hour pH monitor

Basal Cell Hyperplasia

Elongation of the vascular papillae

Intraepithelial eos/polys

Balloon cells

Vascular lakes

Reflux Esophagitis

REFLUX NORMAL

Eos in GERD

Balloon Cells in GERD

Vascular Lakes

IELs in GERD

Is it important to DX Reflux?

Pediatric cases

–A positive biopsy could lead to a fundoplication

Differentiate from allergy/eosinophilic

esophagitis

Differentiate from infection (location is key)

Rule out Barretts

Causes of Intra-epithelial Eosinophils

Causes of Intra-epithelial Eosinophils

Reflux (either acid or alkaline)

Allergy/eosinophilic gastroenteritis

– “Idiopathic Eosinophilic Esophagitis”

Drug/pill induced esophagitis

Infections

Achalasia