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 ).
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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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.