Reflux Esophagitis Grade C: How Serious Is It?

Reflux esophagitis is classified into four grades—A, B, C, and D—based on the extent of inflammation observed during endoscopy. This classification, known as the Los Angeles Classification, evaluates the length and severity of red streaks or erosions above the Z-line in the lower esophagus. Grade C is considered moderately severe but not the most advanced stage.

Understanding the Grading System:

- Grade A: Refers to one or more mucosal breaks (red streaks) no longer than 5mm, which do not extend between two folds. This is the mildest form.

- Grade B: Involves mucosal breaks longer than 5mm, but without merging between folds.

- Grade C: Characterized by multiple mucosal breaks that have begun to merge, covering less than 75% of the esophageal circumference. At this stage, symptoms may become more noticeable and persistent.

- Grade D: The most severe grade, where mucosal breaks cover more than 75% of the esophageal lining, often with circumferential involvement.

Patients diagnosed with Grade C reflux esophagitis typically experience significant symptoms such as heartburn, regurgitation of stomach acid, and retrosternal pain. These symptoms can be triggered by short-term acid reflux episodes, which may respond well to acid suppression therapy. However, if symptoms recur frequently, it could indicate an underlying condition such as a hiatal hernia or chronic belching.

In such cases, treatment should address both acid control and structural issues like hiatal hernia. Depending on the severity, medical management may include proton pump inhibitors (PPIs) and prokinetic agents to improve gastric emptying. For long-standing or refractory cases, surgical intervention such as fundoplication or endoscopic repair might be necessary to strengthen the lower esophageal sphincter and prevent further damage.

Effective management of Grade C reflux esophagitis often requires a comprehensive approach involving lifestyle changes, medication, and sometimes surgery. Without proper treatment, there's a risk of progression to Grade D or complications such as esophageal stricture or Barrett's esophagus, a precursor to esophageal cancer. Early diagnosis and consistent care are key to preventing long-term health issues.