• Esophagus has been opened and is attached to opened proximal stomach

• A small amount of intact smooth white esophageal mucosa (arrow)is still present, but the majority of the red granular surface represents mucosal erosion.

• The red color represents inflamed submucosa

•Multiple etiologies exist for irritation of the esophageal mucosa causing microscopic and clinical esophagitis

•The most frequent are: peptic irritation (gastroesophageal reflux disease (GERD) or nonGERD); infectious (viral, fungal or bacterial); toxic (chemical, cytotoxic chemotherapy); irritants (alcohol, smoking, hot fluids and foodstuffs0

•In the U.S. peptic irritation is the major cause and this involves exposure of epithelium to the caustic effect of acid

•An increasingly common occurrence is fungal or less commonly viral superinfection in an immunocompromised host either due to primary immunodeficiency or secondary to chemotherapy

•Great variation in incidence exists geographically ranging from estimates of 5-10% in the U.S. to 80% in Iran

•In the U.S. the primary cause is gastroesophageal reflux (GERD) while in France it is alcohol consumption and in Iran and the far east dietary

•Dependent on etiology.

•The gross appearance will vary dependant on the etiology

•The common finding is evidence of inflammation with reddening,exudate, debris, possible slight edema and in severe cases erosion or ulceration

•In fungal esophagitis, most commonly Candida, multiple white patches are seen similar to oral thrush

•In Herpes or CMV punched out ulcers are seen

•Radiation will show evidence of epithelial atrophy with thinning rather than signs of inflammation and in late cases narrowing leading to stricture

•Dependent on etiology.

• Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 761-2.

• Current literature from PubMed at National Library of Medicine