The Pathology of Gastroesophageal Reflux Disease

Knowledge Gap: How does chronic acid reflux progress to gastroesophageal reflux disease (GERD), and potentially lead to cancer? 
Design Solution: Show the progressive morphological changes of esophageal tissue on a macroscopic and microscopic scale, when exposed to chronic gastric reflux.  
Print (editorial, magazine)
Project Details: This illustration was produced for a pathology course in the Biomedical Communications program. 
Dr. John Wong
Prof. Shelly Wall
Adobe Photoshop
Adobe Illustrator 
Date Completed 
December 2018
General public 

Problem Solving 


Extensive research was done to better understand the causes of GERD and its progression. Pathology text books and many histology slides were consulted to ensure accurate representation of the pathology. 

Design Process

Colour Studies and Rendering 

Once Dr. Wong approved the accuracy of the information, experimentation with colour could begin. At first, histological stain colours were attempted to represent the microscopic elements of the illustration. However, the purple/pink colour palate did not match the skin-tone colours of the other graphical elements. As a result, earthy colours were used for the entire illustration, which better emphasized and differentiated between key elements. 

Because of the specific visual goals for this illustration, finding the best layout was a challenge. Initially, the stomach was on the right, and the tissue cubes on the left which did not work well. After consulting with Prof. Wall, simply switching these around achieved all of the visual goals, and improved the reading flow of the illustration.  

Frequent communication with Dr. Wong occurred throughout the entire process of this illustration. Multiple feedback sessions took place to better understand the pathology GERD, to better represent the structural elements of the disease, and to better implement key colour recommendations. Important design decisions were made in collaboration with Prof. Wall who helped maximize knowledge translation while decreasing cognitive load. 


Tissue Study 

Before a comprehensive sketch could be developed, a tissue preparatory study was conducted. This time was used to practise drawing the key features of esophageal tissue, and to study how these features  change with disease progression.  

Composition and Layou

The main visual goals for the final composition were three. First, it had to be very clear where in the body this disease occurs. Secondly, GERD had to be shown "in action" i.e. the movement of gastric acid entering the esophagus. Finally, the space for the tissue cubes needed to be maximized to enable clear comparisons of the morphological tissue changes over time. As a result, sketches were made iteratively to find the best layout to achieve these visual goals.  

Website_tissue cubes-01.jpg