Category: Chronic inflammatory, non-neoplastic disease of the esophagus.
Essence: Caused by reflux of gastric contents into the lower esophagus leading to chemical injury of the squamous mucosa.
Clinical: Heartburn, regurgitation, chest discomfort, chronic cough, or dysphagia.
Distribution: Maximal injury at the distal esophagus; may extend proximally in severe cases.
Incompetent lower esophageal sphincter (hiatal hernia, obesity, pregnancy, delayed gastric emptying) → acid and bile reflux → epithelial injury and inflammation → basal cell hyperplasia, elongation of papillae, and chronic inflammatory infiltrate (mostly lymphocytes ± few eosinophils/neutrophils).
Chronic mucosal damage may lead to Barrett esophagus (intestinal metaplasia) and adenocarcinoma risk.
Mild to moderate basal cell hyperplasia (up to one-third of epithelial thickness).
Elongated lamina propria papillae extending into upper third of epithelium.
Mixed inflammatory infiltrate: lymphocytes, occasional neutrophils and scattered eosinophils (<15/HPF).
Surface degeneration or erosion may be present.
In long-standing cases: fibrosis, ulceration, or Barrett metaplasia (intestinal-type with goblet cells).
Diagnosis: Based on morphology and clinicopathologic correlation; no specific immunostains required.
Eosinophilic esophagitis: Marked eosinophilia (≥15/HPF), diffuse (not distal) involvement, lamina propria fibrosis, and allergic history.
Infectious esophagitis (HSV/CMV): Presence of viral inclusions; neutrophilic inflammation rather than chronic reflux changes.
Pill-induced injury: Localized ulcer with necrosis and polarizable debris.
Barrett esophagus: Metaplastic columnar epithelium with goblet cells—often a complication of chronic GERD rather than a mimic.
Esophagus, distal biopsy:
- Squamous mucosa with basal cell hyperplasia, papillary elongation, and mild chronic inflammation, consistent with reflux esophagitis (GERD).