How To Diagnose Reflux Esophagitis

Reflux esophagitis is a form of gastroesophageal reflux disease (GERD), and the most accurate way to confirm its presence and severity is through an endoscopic examination. This procedure allows doctors to directly observe the lower part of the esophagus, particularly above the Z-line, for signs such as linear red streaks or inflammation.

During the endoscopy, the severity of esophagitis can be classified using the Los Angeles (LA) classification system:

If only one or more red lesions less than 5mm in length are observed, it is categorized as LA-A.

When the red streaks are longer than 5mm but remain separate—either single or multiple—it is classified as LA-B.

In cases where some lesions have merged but cover less than three-quarters of the esophageal circumference, the condition is labeled as LA-C.

If the inflamed areas are fully circumferential or involve more than three-quarters of the esophagus, it is considered the most severe stage, LA-D.

In addition to identifying inflammation, endoscopy can also detect complications such as hiatal hernia. A hiatal hernia may appear as a widened opening in the diaphragm with a visible hernia sac, which contributes to a loose lower esophageal sphincter and chronic reflux. In some cases, acute hiccups can cause repeated exposure of the esophagus to stomach contents, leading to acute reflux esophagitis. In such situations, treatment typically involves anti-reflux medications and mucosal protectants to speed up healing.

However, when a hiatal hernia is present, especially with persistent reflux due to a weakened sphincter, treatment outcomes may not be as effective. Early diagnosis and appropriate classification through endoscopy are crucial for determining the best course of treatment and improving long-term outcomes.