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Endoscopy is a frequent mode of investigation in patients in whom reflux esophagitis is suspected. This condition is present in 5 to 10% of all patients undergoing diagnostic EGD • and in 50 to 60% of patients thought to have gastroesophageal acid reflux disease (GERD).1 • 1 • According to endoscopic criteria, esophagitis can be classified into one of four levels: Grade 1 (minimal esophagitis): Erythema of the distal esophagus with capillary dilation and, in some instances, friability of the mucosa.

Grade 2 (mild esophagitis): Loss of definition of the mucosal detail at the gastroesophageal junction with discrete erosions ( Fig. 5-2 ). The erosions take on a deeper red hue than that of the surrounding mucosa and often extend distally to the region of the gastroesophageal junction. Pseudomembrane formation occasionally occurs. Grade 3 (severe esophagitis): Ulcerations with granulation tissue, as evidenced by either an inflammatory exudate or a pale ulcer bed ( Fig. 5-3). There is also evidence of fibrosis within the wall of the esophagus, limiting distensibility during air insufflation. Grade 4 (stricture): The presence of the findings of grade 3 esophagitis as well as a definite narrowing of the esophageal lumen ( Fig. 5-4 ).

Perforation

Figure 5-2 Grade II esophagitis, characterized by linear erosions and ulcerations.

Figure 5-3 Grade III esophagitis, illustrating fibrosis within the esophageal wall, deep ulcerations, and pseudomembrane formation.

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