Oesophagitis

Oesophagitis is the inflammation of the lining of the oesophagus, usually due to irritation by refluxed stomach acid and enzymes.

The lining of the oesophagus can cope with a certain amount of acid; however, it is more sensitive to acid in some people. 30–40% of patients with acid reflux have underlying reflux oesophagitis [Richter, 1992] and are therefore at risk of further oesophageal complications. Such patients have a significant prevalence of oesophageal ulceration (2–7%), oesophageal stricture (narrowing of the oesophagus; 4–20%) and Barrett’s oesophagus (10–15%).[Spechler, 1992]

The extent of the mucosal injury is determined by the duration of time that the mucosa is exposed to damaging refluxate and by the potency of refluxed fluid. Double contrast barium study will normally reveal superficial ulcerations or erosions, usually extending from the gastro-oesophageal junction into the distal portion of the oesophagus. Endoscopy will also reveal the extent of damage (Figure 1).

If oesophagitis is observed, documented grading systems allow specific definitions of its severity. The Savary-Miller grading system (I–IV) is commonly applied.

FIGURE 1 – Different grades of oesophagitis according to the Savary-Miller classification of reflux oesphagitis (images from http://www.gastrolab.net)

Laryngopharyngeal reflux

More to reflux than Acid

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