Esophagitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
If left untreated, 20% of patients with GERD may progress to develop esophageal stricture due to excessive acid in the lower esophagus. Complications of GERD include barrett's esophagus, erosive esophagitis, esophageal ulcer, and esophageal adenocarcinoma. Prognosis of GERD is good with the appropriate treatment.The natural course of primary EoE is, in patients with EoE, symptoms persist over years raising suspicion that a chronic inflammatory process is an underlying event responsible for it. The inflammatory activity is proportional to the density of the eosinophilic infiltration in the esophageal tissue. Similar to asthma, EoE has chronic persistent eosinophilic inflammation and can eventually lead to irreversible structural changes of the esophagus which is called re-modeling of the esophagus. The esophageal mucosa in patients with a longstanding EoE is characterized by a loss of elasticity. On histologic examination of the subepithelial compartments of the esophagus show an increase in the fibrous tissue. In patients with EoE, the chronic eosinophilic inflammation leads to an increased deposition of the fibrous connective tissue which in turn causes the remodeling of the esophagus hindering the esophageal transport.The complications of the EoE are as follows: Scarring of esophagus-leading to dysphagia, Esophageal stenosis, Tears or perforation during the endoscopy or retching leading to boerhaave syndrome. The long-term prognosis of the EoE is unclear but patients diagnosed with EoE have an unaffected lifespan.
Natural History
- The symptoms of esophagitis include heart burn, regurgitation, and dysphagia.
- If left untreated, esophagitis will develop to esophageal stricture which occurs in around 20% of the patients with GERD.[1]
- Esophageal stricture occur due to excessive acid in the lower of the esophagus which lead to scar formation. This scar causes narrowing of the esophagus and lead to difficulties in swallowing.
Complications
- Complications that can develop as a result of esophagitis include the following:[2]
- If untreated, esophagitis may cause severe discomfort and eventual scarring (stricture) of the esophagus, this can cause difficulty swallowing food or medications.
- Barrett's esophagus:
- The risk of progression from Barrett's to dysplasia is uncertain but is estimated to include 0.1% to 0.5% of cases, and has probably been exaggerated in the past.
- Due to the risk of chronic heart burn progressing to Barrett's esophagus, EGD every 5 years is recommended for patients with chronic heartburn, or who take drugs for chronic GERD.
- Esophageal ulcer
- Esophageal adenocarcinoma
Prognosis
- The disorders that cause esophagitis usually respond to treatment.
- The majority of people respond to non-surgical measures, with lifestyle changes and medications. However, many patients need to continue to take drugs to control their symptoms.
References
- ↑ Sonnenberg A, El-Serag HB (1999). "Clinical epidemiology and natural history of gastroesophageal reflux disease". Yale J Biol Med. 72 (2–3): 81–92. PMC 2579001. PMID 10780569.
- ↑ El-Serag HB, Graham DY, Satia JA, Rabeneck L (2005). "Obesity is an independent risk factor for GERD symptoms and erosive esophagitis". Am J Gastroenterol. 100 (6): 1243–50. doi:10.1111/j.1572-0241.2005.41703.x. PMID 15929752.