Though the vaccine is approved for people 9 through 45, it's most effective when administered early. Half of the patients complain of chest pain or heartburn. Likewise, there is evidence to suggest that Helicobacter pylori infection may actually protect against the development of GERD and its complications. Journal of Gastroenterology. doi:10.1016/j.ajog.2016.07.042. Hyperkeratosis is frequently seen with squamous cell hyperplasia. Feeling that something is stuck in your throat. Cytologically, hyperplastic squamous epithelial cells are uniform and do not show loss of polarity or overlapping nuclei. The differential diagnosis of GERD includes infectious esophagitis; pill esophagitis; esophagitis caused by ingestion of corrosive agents such as lye; chemotherapy- and radiation-induced esophagitis; primary EOE; systemic diseases such as collagen vascular disease, Crohns disease, Stevens-Johnson syndrome, various bullous diseases, lichen planus, and graft-versus-host disease; and trauma. Fungal esophagitis is most commonly caused by Candida albicans or Candida tropicalis ( Fig. In some cases, tests done on the cells proteins, DNA, and RNA can help tell doctors if theres cancer. Midesophageal diverticula are termed epiphrenic diverticula and may be related to esophageal motility disorder. Subsequent studies confirmed these initial observations and also demonstrated a significant positive correlation between the severity of reflux, as measured by 24-hour pH score (a composite quantitative evaluation of acid reflux) and the length of the lamina propria papillae. The pathogenesis of EOE is poorly understood and is the subject of intense ongoing research. A type 2 excludes note indicates that the condition excluded is not part of the condition it is excluded from but a patient may have both conditions at the same time. C. tropicalis is more virulent than C. albicans because of its increased potential for tissue invasiveness. Mayo Clinic. } 2023 Caniry - All Rights Reserved The U.S. Centers for Disease Control and Prevention and the ACS recommend HPV vaccination begin between ages 11 and 12 and 9 and 12, respectively. The cause of this disorder is unclear. The reaction may occur as follows: There has been a significant increase in numbers of people diagnosed with eosinophilic esophagitis in the past decade. However, these endoscopic features have been described in other conditions and are not pathognomonic of EOE. You may opt-out of email communications at any time by clicking on Cancer Information, Answers, and Hope. World Journal of Gastroenterology. Because of their squiggly appearance, intraepithelial lymphocytes may resemble granulocytes. What does superficial strips of benign squamous mucosa mean from an esophagus biopsy? Saslow D, Andrews KS, Manassaram-baptiste D, Smith RA, Fontham ETH. High-power view of the base of an esophageal ulcer showing increased inflammation and marked, somewhat atypical reactive mesenchymal cells. Reactive gastric cardiac mucosa displays nuclear atypia that may be . Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. You will also receive Endoscopy revealed plaques or membranes. A prominent inflammatory infiltrate composed of lymphocytes, eosinophils, and plasma cells typically surrounds the pseudodiverticula (see Chapter 24 ). Long-term follow-up studies indicate that the condition may remain stable for long periods. The circumferential extent of columnar metaplasia is 2cm above the gastroesophageal junction (GEJ), and the maximal extent is 5cm (tallest tongue of columnar metaplasia extending above the GEJ). Surgery is indicated in some cases. So KA, Kim MJ, Lee KH, et al. These include ASC-H, atypical squamous cells, cannot exclude HSIL. .st0 { Become a volunteer, make a tax-deductible donation, or participate in a fundraising event to help us save lives. Squamous mucosa in achalasia showed changes mimicking reflux and lymphocytic esophagitis. The inner lining of the esophagus is known as the mucosa. Clinically, patients experience sudden-onset severe chest pain in the lower thorax and upper abdomen after repeated episodes of retching or vomiting. Purdy and colleagues further characterized this entity in 42 patients with increased intraepithelial lymphocytes in the esophagus. Squamous cells are the thin, flat cells that make up the epidermis, or the outermost layer of the skin. Amyloid is usually present in the deeper layers of the esophageal wall, and therefore is not usually detectable in superficial biopsy specimens. It is called squamous mucosa when the top layer is made up of squamous cells. Intercellular edema or dilated intercellular spaces reflecting increased paracellular permeability may be a useful marker of early injury in the absence of endoscopic evidence of injury. Drinking alcohol, smoking cigarettes . Gastroduodenal lesions also are common after ingestion of caustic agents. Other causes of infectious esophagitis, including CMV and Candida, may mimic pill esophagitis, both clinically and pathologically. Acyclovir (Zovirax) can be administered orally and helps initiate healing of active disease, but it does not prevent recurrences. 2020 Jul;70(4):274-280.doi:10.3322/caac.21616, Sundstrm K, Lu D, Elfstrm KM, et al. In immunosuppressed patients, who occasionally reveal only minimal inflammation, special stains (silver stain, periodic acidSchiff [PAS]) should be used to detect small numbers of invasive fungal forms within the tissue. Herpetic ulcers in the esophagus may serve as a portal of entry for other pathogens and can be associated with herpetic pneumonitis. Eosinophilic esophagitis has been identified only since the early '90s, but is now considered a major cause of digestive system illness. The cells in the lining of the stomach or esophagus change to resemble the tissues that line the intestines. We believe that in Barrett's esophagus negative for dysplasia, the epithelium on the mucosal surface should appear normal 2 or 3 glands away from the squamous island. Eosinophilic esophagitis: update on clinicopathological manifestations and pathophysiology. This tube is also called the esophagus. 14.5 ). Coexistent herpes labialis and oropharyngeal ulcers are seen in approximately one fourth of patients. Tissue architecture and cell morphology of squamous cell carcinomas compared to granular cell tumours pseudo-epitheliomatous hyperplasia and to normal oral mucosae. The most helpful distinguishing feature is the presence of cytoarchitectural uniformity in cases of hyperplasia, compared with cytoarchitectural pleomorphism in cases of dysplasia or carcinoma. Elderly patients and women are affected most frequently. Using too many non-steroidal anti-inflammatory drugs, or NSAIDs, like aspirin or ibuprofen can cause ulcers, bleeding, and duodenitis. No. For instance, the basal cells may appear separate from one another but remain attached to the basement membrane. In that study, the observed prevalence rate of the simultaneous occurrence of these two conditions was one third of what would be expected if they occurred independently (odds ratio, 0.29; 95% confidence interval, 0.27 to 0.33; P < .0001). Vesiculobullous dermatoses such as Stevens-Johnson syndrome, pemphigus, and pemphigoid may mimic EDS. They include (1) increased intraepithelial eosinophils (15/HPF) obtained from the most densely populated areas (peak density), (2) eosinophilic microabscesses (defined as a collection of four or more eosinophils within the epithelium), (3) surface layering of eosinophils (i.e., affiliation of eosinophils to occupy the outer layer of the squamous epithelium), (4) surface sloughing of squamous cells mixed with abundant eosinophils, and (5) extracellular eosinophilic granules (deposition of these proteins, including eosinophil peroxidase and eosinophil derived neurotoxin, indicates degranulation). These findings provide further support for an alternative concept for the development of reflux esophagitis in humans. Dysphagia, refusal to drink, and mouth or chest pain, with drooling and salivation, may ensue. What percentage of esophageal tumors are benign? Since squamous cell hyperplasia is similar to other nonmalignant vulvar conditions, your OBGYN may suggest a biopsy to confirm the diagnosis. Cryotherapy. After 2 to 4 months, the acute clinical manifestations (inflammation of the eye, conjunctivitis, palpebral edema, periauricular satellite adenopathy, and generalized infection) disappear and the disease enters a period of clinical latency (indeterminate form). Resolution is often demonstrated when the drug is withdrawn from use. Most symptomatic strictures require dilation to fix the problem. Data from Furuta GT. 14.13 ). Reactive changes are benign (non-cancerous). GASTRIC ANTRAL AND OXYNTIC MUCOSA WITH CHRONIC INACTIVE GASTRITIS: pt has chronic gastritis with no acute signs present = K29.50 NEGATIVE FOR HELICOBACTER PYLORI TYPE ORGANISMS BY IMMUNOHISTOCHEMISTRY: CLO test negative SQUAMOUS MUCOSA WITH REFLUX ESOPHAGITIS: GERD = K21.9 NEGATIVE FOR FUNGAL ORGANISMS: candidasis test negative P pajohnson Guru Other endoscopic findings include transient esophageal rings (also known as feline folds or felinization), mucosal plaques or exudates, longitudinal furrows, edema, diffuse esophageal narrowing, narrow-caliber esophagus, and mucosal tears readily induced by passage of the endoscope ( Table 14.3 and Fig. information and will only use or disclose that information as set forth in our notice of It also may be found in otherwise healthy patients. K22.89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. On endoscopic examination, patients with erosive esophagitis reveal erosions, ulcers, strictures, or some combination of these. Eosinophil activation by IL5, IL13, and eotaxin 3 results in extracellular release of cytotoxic granules. Treating abnormal squamous epithelial cells depends on the Pap smear diagnosis. Surdea-Blaga T, et al. Over time, gerd can cause damage to the esophagus. Histologically, at low power, the biopsy samples consist of long, detached fragments of superficial squamous epithelium with some degree of intraepithelial splitting at varying levels above the basal layer of the squamous epithelium, occasionally associated with separation of the epithelial layers to form bullae. In difficult cases, immunohistochemistry for cytokeratins can be helpful in differentiating true carcinoma (positive) from reactive pseudosarcomatous alterations of the stromal cells (negative). Precipitating factors include retching, vomiting, straining, coughing, blunt abdominal trauma, and cardiopulmonary resuscitation. Initially (within the first 48 hours), one encounters apoptotic bodies in the mucosal basal zone. Microscopically, distal muscular hypertrophy and mononuclear inflammatory infiltrates occur in the muscle layers. Goblet cells are rare in patients younger than 10 years of age but increase in number progressively with age. My 13 y/o had an endoscopy done and bx report shows on the esophagus mild hyperemic squamous mucosa changes.what does this mean? Results of cell amounts are usually reported as approximates, such as "few," "moderate," or "many" cells. Lymphocytic esophagitis was first recognized in 2006. }. As much as one third of GERD patients who lack columnar mucosa within the distal esophagus show intestinal metaplasia (goblet cells) in their otherwise anatomically normal GEJ, and these patients do not qualify as having BE based on the ACG definition. Because intraepithelial eosinophils in both conditions may be patchy in distribution, sampling error can also affect ones ability to establish a correct diagnosis. Endometrial biopsy showed "fragments of endocervical mucosa with focal tubal and squamous metaplasia and reactive changes." There are data to suggest that most patients with at least 2cm of columnar-lined esophagus are found to have intestinal metaplasia if enough biopsy samples are obtained from the columnar-lined segment. Although many patients are asymptomatic, some experience dysphagia, regurgitation, aspiration, or other symptoms of esophagitis. Nuclear and cytoplasmic degeneration and multinucleation are common. The incidence of . Defining BE by pathologic confirmation of intestinal metaplasia (goblet cells) is problematic for a few other reasons as well. Several studies have evaluated the risk of dysplasia and cancer in relation to the length of BE. However, in some reports, patients with quinidine- or potassium chlorideinduced injury were shown to have a history of external esophageal compression, such as valvular heart disease with left atrial enlargement, or esophageal entrapment by fixed mediastinal structures and adhesions after thoracic surgery. However, chronic bullous diseases can be excluded by demonstration of an absence of complement and immunoglobulin deposits by direct immunofluorescence (DIF), lack of anti-desmoglein antibodies by enzyme-linked immunosorbent assay (ELISA), and lack of corresponding cutaneous and oropharyngeal lesions. In fact, progression of GERD to BE in the general population may be higher than previously recognized. Most of theesophagus is lined by squamous mucosa. American Partnership for Eosinophilic Disorders. "Benign endocervical tissue" means there is normal, non-cancerous tissue from the endocervix. In the last 6 years, more than 35 faculty members have joined us, and we continue to expand. This tube is also called the esophagus. tissue.can you help understand? If a careful search of well-prepared, routinely stained tissue sections or cytology preparations fails to reveal CMV inclusions, or at least suspicious cells, then additional ancillary immunohistochemical or in situ hybridization tests may be helpful. Scleroderma has been associated with an increased risk of BE and its neoplastic complications. Both are almost 100% effective in curing the disease if treatment is begun soon after infection, at the onset of the acute phase, but their efficacy diminishes with time and duration of infection. Pinch biopsies obtained through standard endoscopes are often not adequate for evaluation of early histologic changes resulting from reflux because they usually do not include the entire thickness of the mucosa and are difficult to orient. Although the clinical significance of lymphocytic esophagitis remains to be defined, evidence suggests that this condition probably represents injury by a variety of potential insults, although an autoimmune etiology has been postulated in some cases. } !1AQa"q2#BR$3br Squamous cells are thin, flat cells that look like fish scales, and are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the lining of the respiratory and digestive tracts. as is intraepithelial eosinophilia. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. The increased risk associated with longer lengths of BE has been attributed to a larger surface area at risk for neoplastic progression. However, in 1970, Ismail-Beigi and co-workers found that some patients who had clinical symptoms of GERD but a normal or only minimally abnormal endoscopic appearance showed hyperplasia of the squamous epithelium, a finding that they postulated was an early histologic manifestation of reflux-induced injury. Usually, a definite diagnosis is established only when characteristic histologic features (strictures, deep ulcers, transmural inflammation, granulomas, mural fibrosis) are identified in the esophagus of a patient who is known to have Crohns disease elsewhere in the GI tract ( Fig. Herpes simplex type I is the most common cause of herpetic esophagitis, but on morphologic grounds, this type cannot be distinguished from herpes simplex type II or varicella-zoster. How do you know if something is stuck in your esophagus? Others consider a sudden increase in intraabdominal pressure to be the causative factor. Barrett's esophagus is a complication of chronic gastroesophageal reflux disease and can be diagnosed when there is an endoscopic abnormality in which a biopsy shows evidence of specialized columnar epithelium, characterized by the presence of acid mucin-containing goblet cells. Eotaxin 3 (now called CCL26 ), a gene that encodes a component of the immunologic cascade, has been shown to be highly induced in patients with EOE compared with healthy controls. They are usually distributed in a scattered fashion within otherwise typical granulation tissue. Hoarseness. Hence, the diagnostic hallmark of pemphigus vulgaris is acantholysis with bulla formation in the suprabasal region combined with a row of tombstone-like basal cells. Because Candida organisms are part of the normal flora of the GI tract, confirmation of this diagnosis requires more than simply identifying budding yeast forms; pseudohyphae should be detected within tissue to document true infection. There is nothing scary in those results. Northeast Ohio 216.444.7000 However, in herpes esophagitis, one usually sees a halo located between the nuclear inclusion and the nuclear membrane. BE is characterized by the conversion of normal squamous epithelium of the esophagus into metaplastic columnar epithelium. A recent report showed that BE may develop in children with reflux symptoms after a mean period of 5.3 years. R. Abu-Eid and G. Landini. For example: Active esophagitis characterized by abundant eosinophils (>15/HPF). Squamous epithelial cells are a type of flat cell found throughout the body, including in the mouth, on the lips, and on the cervix. enable-background: new; Depending on circumstances, over time, healthy cells may replace these transformed cells or they may continue growing abnormally and become cancerous. 14.25 ). include protected health information. https://gi.org/topics/eosinophilic-esophagitis-in-pediatric-and-adolescent-patients/#:~:text=Infants%20and%20toddlers%20with%20EoE,)%2C%20especially%20with%20solid%20meals. $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ? They also are not specific for GERD. Most people have nonkeratinizing cervical squamous metaplasia. When you receive this diagnosis, it means that the squamous epithelialcells found in the cervix have taken on an abnormal morphology, or shape but aren't necessarily cancerous. This scoring system has been shown to be reliable in assessing the extent of endoscopic BE ( Fig. B@ $ '/>Jxk^uM6_jr]]ia=`m In less dramatic cases, the condition varies from sloughing of large fragments of the esophageal squamous mucosa, which may be coughed up or vomited, to a condition that is not even suspected until the endoscopist notices whitish strips or streaks (pseudomembranes) of peeling esophageal mucosa during an endoscopic examination performed for reasons that may be unrelated to the esophagus. Nguyen HT. Its also important to follow recommended screening guidelines, which can help detect certain cancers early. This includes the amount of epithelial cells your urine contains. This series of Frequently Asked Questions (FAQs) was developed by the Association of Directors of Anatomic and Surgical Pathology to help patients and their families better understand what their pathology report means. No single technique is 100% sensitive in establishing a diagnosis of CMV esophagitis. Repeated dilations may be needed to prevent the development of recurrent strictures. In addition, functional obstruction of the LES may be induced by a fundoplication or by gastric banding procedures. Gmez-Aldana A, et al. Enter the email address you signed up with and we'll email you a reset link. Non-cancerous tumours or conditions are not usually life-threatening. However, there are no anatomic landmarks demarcating the beginning and end of this physiologic sphincter. A common excisional method is known as a loop electrosurgical excision procedure (LEEP), where abnormal cells are cut away by a wire loop that's heated with an electric current. Squamous hyperplasia is characterized by increased numbers of squamous cells resulting in increased thickness of the squamous epithelium, which may be diffuse or plaque-like or form blunt papillary projections. 14.11 ). 2.1 Structure of normal esophagus. Often, they have fever or pain after forceful vomiting, esophageal instrumentation, or chest trauma. UpToDate. Intravenous medications may be indicated for severe disease. With this disease, a type of white blood cell, called an eosinophil, builds up in the lining of the tube that connects your mouth to your stomach. %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz The cause of esophageal webs is unknown, but they are associated with an array of conditions, including cutaneous blistering disorders (e.g., epidermolysis bullosa, cicatricial pemphigoid), Zenker diverticula, esophageal duplication, and cysts. negative for. Endoscopically, CMV esophagitis has a variable appearance. By definition, patients have normal or near-normal pH monitoring levels and fail to respond to antireflux therapy, although a subgroup of patients do respond to PPIs, so the association with reflux is controversial. GERD is an extremely common chronic condition, particularly in Western countries. 14.7 ). In addition, eosinophils in the lamina propria are considered an even more sensitive indicator of GERD in infants. A urinalysis is a standard test that analyzes the substances in your urine. Symptoms related to esophageal disease are common in AIDS patients. Sometimes this area is sampled when the esophagus is biopsied. Columnar mucosa from the distal esophagus of a patient without histologic evidence of goblet cells. 14.9 ). Therefore, an accurate diagnosis of reflux esophagitis requires correlation with the patients clinical, endoscopic, manometric, and histologic data. 14.6 ). Other symptoms in adult patients include solid-food dysphagia, chest pain, food impaction, and upper abdominal pain. One report suggested that the majority of patients with pemphigus vulgaris who undergo endoscopy with biopsy show evidence of esophageal involvement. Treatment of EOE with cromolyn sodium, leukotriene receptor antagonists, or immunosuppressive agents is not recommended. Esophageal injury is a common side effect of chemotherapy and radiation therapy. In one study, CMV infection was found either alone or in combination with Candida and herpes in 30% of AIDS patients. Echinocandins (e.g., Caspofungin), a new class of antifungal agents that act on fungal cell walls, are being used in randomized trials for patients with Candida esophagitis refractory to azole compounds. 14.22 ). It is helpful to establish a temporal clinicopathologic association between use of the drug, onset of symptoms, and tissue eosinophilia in determining that diagnosis. This content does not have an English version. The long-term outcome for patients with EOE who receive treatment, and the proportion of patients who require multiple courses of treatment, are unknown. Neutrophils and eosinophils may be present within the epithelium, but these inflammatory cells are not a prominent feature of this condition. Viruses and fungi cause most forms of acute infectious esophagitis. The esophagus may be affected in many different types of primary dermatologic conditions, including drug-induced diseases such as Stevens-Johnson syndrome and bullous diseases such as bullous pemphigoid, benign mucous membrane pemphigoid, epidermolysis bullosa acquisita, pemphigus vulgaris, and lichen planus (see Chapter 6 ). Muoz-Bellido FJ, et al. Renita White, MD, FACOG, is a board-certified obstetrician/gynecologist. Between 40% to 80% of patients have a history of heavy alcohol use leading to vomiting. The mucosal subtype is the most common (25% to 100%), perhaps because of its accessibility to diagnosis by routine endoscopy and biopsies. Presenting symptoms may include odynophagia, nausea, substernal pain, and fever. For potential or actual medical emergencies, immediately call 911 or your local emergency service. American College of Gastroenterology. Is Squamous Mucosa Normal? What is Barrett's Esophagus? To provide you with the most relevant and helpful information, and understand which The ACS recommends against HPV vaccination for most people older than 27 due to low effectiveness and a vaccine shortage. Of the 119 study cases, more than two thirds of patients had symptoms of dysphagia or odynophagia that elicited clinical suspicion for EOE or GERD. Herpes esophagitis is often a major consideration; a clinical history of immunosuppression and identification of characteristic viral cytopathic inclusions is useful in this differential diagnosis. The nuclei may be uniformly enlarged; however, they have smooth nuclear membranes, open chromatin, often prominent nucleoli, and increased mitoses but no atypical mitoses. Histologic examination in animal models has demonstrated that infiltration of the submucosa by lymphocytes is an early manifestation of inflammation. There is also a Pap smear diagnosis of atypical glandular cells (AGC). 14.20 ). Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. It can be given up until age 26, depending on the circumstances. The presence of hiatal hernia is also considered a predisposing factor and is found in 35% to 100% of patients. In this context, annotation back-references refer to codes that contain: This is the American ICD-10-CM version of, certain conditions originating in the perinatal period (, certain infectious and parasitic diseases (, complications of pregnancy, childbirth and the puerperium (, congenital malformations, deformations and chromosomal abnormalities (, endocrine, nutritional and metabolic diseases (, injury, poisoning and certain other consequences of external causes (, symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (. Computed tomography (CT) scan for esophageal cancer uses X-ray images to present detailed images of the esophagus and surrounding tissues. Esophageal lesions are similar to those in the skin, revealing subepithelial blisters formed by the separation of the esophageal squamous epithelium, with degenerated basal cells from the lamina propria in a clean plane of cleavage without significant inflammatory response. Traditionally, BE has been separated into long-segment, short-segment, and ultrashort-segment types, depending on the length of involved esophageal mucosa (>3cm, 1 to 3cm, or <1cm, respectively). Studies performed in endemic areas have provided clinical and radiologic evidence of esophageal disorders in 7% to 10% of people with chronic T. cruzi infection, and megaesophagus in 3%. The cardia is the part of the stomach near the place that the esophagus enters the stomach. Research. A type 2 excludes note represents "not included here". The number of bacteria appears to be inversely related to the intensity of the inflammatory reaction. 2023 American Cancer Society, Inc. All rights reserved. Multinucleated giant cell changes in squamous epithelial cells may occur in reflux esophagitis and should not be confused with the cytopathic effects of herpesvirus infection. 14.1 ). Whether you want to learn about treatment options, get advice on coping with side effects, or have questions about health insurance, were here to help. All rights reserved. clip-path: url(#SVGID_2_); Hybridization with specific DNA probes may reveal Epstein-Barr virus in some of these patients. However, they may also take a wait and see approach. A variety of conditions can cause histologic features similar to those found in pill esophagitis. Review/update the You can unsubscribe at any In most, a specific infectious agent such as Candida , herpes simplex, varicella-zoster, or CMV can be identified. Crohns disease never involves the esophagus in the absence of stomach, small intestine, or colon involvement, and other features such as erosions, sinuses, fistulas, neutrophils, and increased lymphoid tissue are often present in addition to increased eosinophils. What Is The Average Cost Of Lively Hearing Aids? Submucosal fibrosis, mural scarring, and strictures also may complicate deep-seated chemoradiation-induced esophageal ulcers. Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases. However, this procedure usually needs to be repeated regularly and does not reduce the degree of inflammation. Chronic vascular alterations include the development of sclerosis, intimal foam cell arteriopathy, and obliterative vasculitis. An endoscope a long, flexible tube equipped with a camera may be used to see inside your esophagus. The histologic features of GERD and EOE overlap (see Table 14.4 ). ,Photoshop 3.0 8BIM% B~ C C l " Treatments include: Antibiotics to treat infections. The resulting inflammatory response leads to the pathologic changes observed in the mucosa, submucosal fibrosis, remodelling, and esophageal strictures. On occasion, herpetic esophagitis may be difficult to distinguish from squamous dysplasia/carcinoma ( Table 14.2 ). On occasion, marked reactive (pseudoepitheliomatous) hyperplasia related to reflux esophagitis may resemble squamous dysplasia histologically ( Fig. We can also help you find other free or low-cost resources available.