• Caused by lower oesophageal sphincter (LOS) incompetence
• Symptoms: heartburn, acid regurgitation, chest discomfort, worse on lying/bending
• Risk factors: obesity, smoking, alcohol, pregnancy, hiatus hernia
• Diagnosis: clinical; consider OGD if red flags (dysphagia, anaemia, weight loss)
• Treatment:
o First-line: proton pump inhibitors (PPIs)
o Lifestyle: weight loss, raise head of bed, avoid triggers (caffeine, alcohol)
• Inflammation secondary to acid reflux
• Graded endoscopically (Los Angeles classification: A–D)
• May cause erosions, ulcers, strictures if severe
• Management: long-term acid suppression (PPI), reassess for Barrett’s if chronic
• Metaplasia of distal oesophageal squamous epithelium to intestinal-type columnar epithelium
• Risk factor: chronic GORD
• Significance: ↑ risk of oesophageal adenocarcinoma
• Surveillance: regular endoscopy with biopsies (based on degree of dysplasia)
• Treatment:
o No dysplasia: high-dose PPI, surveillance
o Dysplasia: endoscopic ablation (e.g. RFA), resection
• Failure of LOS relaxation + absent peristalsis
• Symptoms: dysphagia to solids and liquids, regurgitation, weight loss
• Diagnosis:
o Barium swallow: classic bird-beak appearance
o Manometry: absent peristalsis, ↑ LOS tone
o OGD to exclude malignancy
• Management:
o Pneumatic balloon dilatation
o Heller’s myotomy ± fundoplication
o Botulinum toxin (temporary relief)
• Squamous cell carcinoma:
o Affects upper/middle third
o Risk: smoking, alcohol, achalasia, caustic injury
• Adenocarcinoma:
o Affects lower third, arises from Barrett’s
o Increasing incidence in Western countries
• Features: progressive dysphagia, weight loss, hoarseness, cough
• Diagnosis: OGD + biopsy
• Staging: CT, PET-CT, EUS
• Treatment: surgery ± chemoradiotherapy (depends on stage)
• Candida oesophagitis:
o White plaques on OGD
o Common in immunosuppressed
o Rx: oral fluconazole
• Herpes simplex virus (HSV):
o Volcano-like ulcers
o Rx: aciclovir
• Pill-induced oesophagitis:
o Local irritation (e.g. doxycycline, bisphosphonates)
o Prevent by taking pills upright with water
• Eosinophilic oesophagitis:
o Young adults with atopy/allergies
o Food bolus obstruction, dysphagia
o OGD: trachealisation/rings; biopsy confirms eosinophils
o Rx: topical steroids, dietary exclusion
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
