Grade IIV Reflux Esophagitis

The inflammatory lesions of reflux esophagitis are currently graded according to the Savary-Miller classification, which is summarized in Table 3.4.

Grades I-III. Grades I-III (Fig. 3.25) reflect a more or less pronounced acute attack. These grades may be complicated by superficial bleeding, but some cases initially resolve without sequelae.

Grade IV. Grade IV (Fig. 3.26) represents the chronic, complicated stage of reflux esophagitis, which is subject to its own dynamic. The most serious complications are obstructive strictures and adenocarcinoma secondary to columnar metaplasia of the esophageal epithelium.

Table 3.4 Endoscopic classification of reflux esophagitis, after Savary and Miller (1978)

Grade

Endoscopic findings

I

One or more nonconfluent, longitudinal mucosal lesions with erythema and exudate

II

Confluent erosive and exudative lesions not covering the entire circumference of the esophagus

III

Erosive and exudative lesions covering the entire circumference of the esophagus

IV

Chronic mucosal lesions such as ulcer, stricture, and Barrett esophagus

- Fig. 3.25 Grading of reflux esophagitis

- Fig. 3.25 Grading of reflux esophagitis

Grade Esophagitis

a Grade I: streaky lesions b Grade II: streaky, confluent lesions c Grade III: circumferential lesions a Grade I: streaky lesions b Grade II: streaky, confluent lesions c Grade III: circumferential lesions

Pictures Reflux Esophagitis

Fig. 3.26 Grade IV reflux esophagitis a Ulcer b Barrett epithelium c Peptic stricture

Fig. 3.26 Grade IV reflux esophagitis a Ulcer b Barrett epithelium c Peptic stricture

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