Endoscopic Features of Reflux Esophagitis

Reflux esophagitis can present various appearances during endoscopic examination. One of the most common signs is mucosal erosion, which may progress to ulcers or even esophageal strictures in more severe cases. The severity of this condition is typically classified using the Los Angeles Classification system, which categorizes the disease into four grades: A, B, C, and D.

Grade A represents the mildest form of the disease. It is diagnosed when there is one or more mucosal breaks present, each measuring less than 5 mm in length.

Grade B indicates a slightly more advanced stage, where there are one or more mucosal lesions, with at least one lesion exceeding 5 mm in length. However, these lesions remain separate and do not merge with each other.

Grade C is characterized by the presence of multiple mucosal breaks that have begun to coalesce. However, the combined affected area still involves less than 75% of the esophageal circumference.

Grade D is the most severe classification and occurs when the merged mucosal damage covers 75% or more of the esophageal lining. This stage may also involve complications such as ulcers, gastrointestinal bleeding, or the development of esophageal narrowing.

In addition to these classifications, there is a special variant known as Barrett's esophagus. This condition occurs when the normal squamous epithelium of the esophagus is replaced by columnar epithelium, which is a significant risk factor for the development of esophageal adenocarcinoma. Barrett's esophagus is considered a unique and important subtype of reflux esophagitis due to its long-term clinical implications.