Esophagitis other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Endoscopy or Ultrasound

Endoscopic Findings

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Removal of a piece of tissue from the esophagus for further examination (biopsy)

• 
  Candida esophagitis
• 
  NSAID esophagitis
• 
  Peptic esophagitis

• 
  Herpetic esophagitis
• 
  Caustic lye esophagitis

Reflux esophagitis

• The endoscope has been before one of the diagnostic tools for GERD.
• Endoscopy is not recommended now for the diagnosis of GERD with the typical symptoms, however, it is used in screening for the GERD complications as esophagitis, esophageal strictures, and barrett's esophagus.
• Endoscopy is also beneficial in doing biopsies in the screening of barrett's esophagus.

Eosinophilic esophagitis

• Mucosal biopsies of the esophagus should be obtained in all patients in whom EoE is a clinical possibility regardless of the endoscopic appearance.
• Endoscopic abnormalities in patients with EoE are as follows:
  • Fixed esophageal ring which is corrugated
  • White exudate
  • Longitudinal furrows
  • Mucosal pallor
  • Diffuse esophageal narrowing
  • Mucosal fragility leading to esophageal lacerations during the endoscopy
• However, because these endoscopic features have been described in other esophageal disorders, none can be considered pathognomonic for EoE.

• 
  Endoscopy of the esophagus: Eosinophilic esophagitis
  Source: Wikimedia

Biopsy in EoE

• Characteristic features are as follows:
  • > 20 eosinophils/0.24 mm2.
  • Papillae are elongated
  • Papillae reach into the top 1/3 of the epithelial layer
  • Basal cell hyperplasia; > 3 cells thick or >15% of epithelial thickness

H&E stain of esophagus biopsy showing eosinophilic esophagitis, manifested by an infiltration of eosinophils in the lamina propria

References

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