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Reflux -Acid or Alkaline Allergic Iatrogenic -Pill induced or NG tube Infectious

Esophagitis. Reflux -Acid or Alkaline Allergic Iatrogenic -Pill induced or NG tube Infectious. Reflux Disease. Clinical: Heartburn Endoscopic: Erythema, red streaks, ulcers Histologic: Squamous hyperplasia, inflammation (eos, pmns) Physiologic: 24-hour pH monitor.

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Reflux -Acid or Alkaline Allergic Iatrogenic -Pill induced or NG tube Infectious

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  1. Esophagitis • Reflux • -Acid or Alkaline • Allergic • Iatrogenic • -Pill induced or NG tube • Infectious

  2. Reflux Disease Clinical: Heartburn Endoscopic: Erythema, red streaks, ulcers Histologic: Squamous hyperplasia, inflammation (eos, pmns) Physiologic: 24-hour pH monitor

  3. Reflux Esophagitis • Basal Cell Hyperplasia • Elongation of the vascular papillae • Intraepithelial eos/polys • Balloon cells • Vascular lakes

  4. NORMAL REFLUX

  5. Eos in GERD

  6. Balloon Cells in GERD

  7. Vascular Lakes

  8. IELs in GERD

  9. 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

  10. Causes of Intra-epithelial Eosinophils • Reflux (either acid or alkaline) • Allergy/eosinophilic gastroenteritis • “Idiopathic Eosinophilic Esophagitis” • Drug/pill induced esophagitis • Infections • Achalasia

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