Reflux esophagitis is due to the role of acid reflux gastric mucosa caused by inflammation, the mucosal injury depends on:
① esophageal reflux clearance to the elimination of power;
② reflux contacts the length of material;
③ on esophageal reflux the special role of mucosa.
Reflux esophagitis, according to stages of development can be divided into three different, that is, early, medium and late. One of the most characteristic of early lesions, while in advanced with the other types of esophagitis, it is difficult to identify.
(1) early, that is a minor period of disease: early, sometimes without esophageal mucosal abnormalities or showed diffuse and plaque, Picchi at the end of the cell thickness, papillary lamina extended into the cortex. Is due to reflux on esophageal mucosal stimulation, leading to the surface of cell injury, basal cell surface in order to repair damaged cells and hyperplasia. Extension of the lamina propria papillae, this area is the result of increased blood supply.
Many scholars in the early Ismail-Beigi reflux esophagitis standard for pathological diagnosis:
① basal cell hyperplasia, the epithelial thickness of more than 15% of the thickness (normal thickness of about 10%);
② increase the depth of lamina propria papillae, the depth of large in 66% of epithelial thickness (normal thickness of less than 66%). These changes alone, even in the absence of histological abnormalities in other circumstances, can also be diagnosed.
In addition, such as that Jessurun reflux esophagitis the esophageal squamous epithelial cells change in a balloon-like cells. In 10 cases of reflux esophagitis in seven cases to see the balloon-like cells. 25 cases of suspected clinical reflux esophagitis patients, found 16 cases of balloon-like cells. Some academics have suggested that reflux esophagitis the esophageal epithelial cells with eosinophilic to other organizations in the absence of unusual circumstances occur, the number of endoscopic inflammation observed has nothing to do. Seefeld believe that the inherent membrane found in the eosinophilic and neutrophilic two cells, the diagnosis of anti-reflux esophagitis of decisive significance. It should be noted that esophageal mucosal eosinophilic cells found not reflux esophagitis of the inherent characteristics of eosinophilic cell histiocytosis and eosinophilic gastroenteritis in patients with esophageal mucosal cells can also be found in significant eosinophil infiltration. Except only in both cases, eosinophilic epithelial cells appear only as reflux esophagitis, a histological diagnosis.
Geboes, such as the view that the lamina propria superficial papillary telangiectasia, and to epithelial growth and red blood cell infiltration within the epithelium is a reliable early sign of esophagitis. However, only telangiectasia, together with other anomalies occur when a meaningful change, there is not sufficient alone for the diagnosis of reflux esophagitis.
To sum up, reflux esophagitis, even in early lesions, but also a dynamic process of change, rather than a static state, in the pathological changes, showing little difference. Ismail-Beigi Therefore, in the basis of criteria, depending on the extent of the disease reflux esophagitis early lesions are divided into three:
Grade Ⅰ: Squamous cell growth at the end of the Picchi, the thickness of the whole epithelial layer thickness of 15%. Shallow lamina congestive telangiectasia. Occasional intraepithelial eosinophil.
Grade Ⅱ: squamous cell extended downward angle. Upward extension of the lamina propria papilla epithelial thickness of more than 60%. Telangiectasia shallow hyperemia, occasional bleeding and neutrophil. Eosinophilic epithelial cells were seen, occasional neutrophil.
Ⅲ grades: in grade Ⅱ, based on the inherent neutrophil cell membrane can be seen with the chronic inflammatory cell infiltration, and sometimes it can be seen that local capillary and fibroblast proliferation, the formation of granuloma-like structure.
(2) medium-term, that is, the progress of erosive inflammatory stage: endoscopy, esophagus can be seen along the long axis of the formation of stripe-shaped erosion zone, histology can be seen falling necrosis epithelial lesion area, resulting in superficial epithelial defect, defect from cellulose membrane inflammatory coverage, can be seen under the neutrophils, lymphocytes, plasma cell infiltration. Mainly in the mucosal inflammatory changes more than muscle, the other visible parts of superficial capillaries and fibroblast hyperplasia, formation of chronic inflammatory or granulation tissue of the more complex.
(3) the latter, that is, the formation of ulcers and inflammatory proliferative phase: histological change by mucosal ulceration extended to the submucosa layer, ulcers were integrated or isolated, and appear circular. Ulcer lesions organized into layers, the surface of exudative fibrinous material, under the necrotic tissue from hyperplasia of fibroblasts, new capillaries, chronic inflammatory cells or neutrophilic cells in the granulation tissue of necrotic tissue, the at the bottom is formed by the bud scar tissue organizations.
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