[Endoscopic & histopathologic features of esophageal ulcers. Considerations in 13 cases]

Chronic, severe reflux esophagitis can be complicated with an esophageal ulcer (EU), whose histomorphological characteristics change sensibly. Between 1983 and 1989, 18 EU were endoscopically identified in 13 (6%) out of 217 patients with chronic gastroesophageal reflux (GER). 2 groups were defined: EU and esophagitis, without columnar-lined esophagus and EU with localized columnar metaplasia or Barrett's esophagus. In the first, 4 Wolf's ulcers (WU) were present; in the second, there were 8 Barrett's ulcers (BU), 2 Savary's ulcers (SU) and 4 ulcers with intermediary characteristics (IU). The 24 h esophageal Ph monitoring demonstrated the reflux pathogenesis in all the patients (57%: alkaline reflux). The histomorphological findings of the EU could support the hypotesis that their variety is related to the different stage of the reflux disease. The EU, started as a peptic lesion on a stratified squamous mucosa (WU), due to an acid, alkaline or mixed reflux, would macroscopically turn into a BU, through intermediary entities (SU, IU), with a progressive extension of columnar metaplasia to the adjacent epithelium and walls. It's not possible to exclude the primitive development of the BU in a Barrett's mucosa, because of an alkaline reflux or because of a low mucosa's resistance (specialized columnar epithelium) to a prolonged acid exposure.