Your Esophagus Pathology Report: Reactive or Reflux Changes

Biopsy samples taken from your esophagus (typically during an endoscopy) are studied by a doctor with special training, called a pathologist. After testing the samples, the pathologist creates a report on what was found. Your doctor can then use the pathology report to help manage your care.

The information here is meant to help you understand medical terms you might find in your pathology report after an esophageal biopsy.

About the esophagus

The esophagus is a hollow, muscular tube that connects the mouth and throat to the stomach.

The esophagus meets the stomach at a place called the gastroesophageal junction(GEJ), also known as the esophagogastric junction (EGJ). When you’re eating or drinking, a special ring of muscle near the GEJ, called the lower esophageal sphincter (LES), opens to allow food and liquids in the esophagus to enter the stomach. At other times, the LES normally stays closed to keep the stomach’s acid and digestive juices from going back up into the esophagus.

Normally, the inner lining of the esophagus (mucosa) is made up mainly of squamous cells. Squamous cells are flat cells that look like fish scales when viewed with a microscope.

Reactive changes

A number of things can injure the squamous lining of the esophagus. The esophagus reacts to the damage by trying to repair itself. This creates reactive changes that can be seen under the microscope.

For example, in some people, acid from the stomach can back up into the lower part of the esophagus. The medical term for this is gastroesophageal reflux disease (GERD), or just reflux. Certain medicines and infections can also damage the lining of the esophagus.

Reactive changes and cancer risk

Having reactive changes in your esophagus does not mean that you will get cancer. Still, the process that is causing the reactive changes needs to be treated so the esophagus can heal and the lining can go back to normal.

Reflux changes

As noted above, when stomach acid backs up into the esophagus, it is called reflux. When the esophagus is exposed to the acid over a long time it can damage its squamous lining. This causes certain changes that the pathologist can see with a microscope.

Reflux and cancer risk

Reflux most commonly causes reactive changes in the lining of the esophagus. By itself, reflux does not cause cancer. However, if reflux occurs over a long time, it can also lead to other changes in the lining of the esophagus that can increase the risk of cancer, such as Barrett’s esophagus. Because of this, reflux is considered a risk factor for esophageal cancer.

Your doctor will work with you to treat your reflux, which might help prevent more problems from developing in your esophagus.

Gastric cardiac-type mucosa

If your report mentions gastric cardiac-type mucosa, it means that the cardia, which is the part of the stomach near where it connects to the esophagus, was also biopsied when the esophagus was biopsied.

Your report might also mention reactive changes or inflammation in the cardiac-type mucosa, which occurs when these cells are irritated.

Inflammation can be caused by stomach acid or by infection. The most common cause of infection is the bacterium Helicobacter pylori (also known as just H. pylori). When the stomach gets infected with H. pylori, it can cause problems like gastritis (irritation of the stomach) and stomach ulcers.

If you have these types of changes, your doctor will talk to you about possible treatment options.