Endoscopic grading of reflux oesophagitis: What observations correlate with gastro-oesophageal reflux?

Background: The recognition of minor endoscopic changes is important in correctly diagnosing patients with reflux oesophagitis, but the significance of minor lesions and what observations to use in endoscopic classification are disputed. Our aim was to relate endoscopic observations in reflux oesophagitis with the severity of gastro-oesophageal reflux. Methods: On endoscopy of 64 consecutive untreated patients with uncomplicated reflux oesophagitis, accurate records were made prospectively of the following variables: axial extent of endoscopic changes, width of the lesions, presence of whitish exudate in the lesions, and presence and length of a hiatal hernia. Multiple linear regression analysis examined which of these factors were significantly related, at the 5% level, with gastro-oesophageal reflux as measured at intraoesophageal 24-h pH-metry. Results: Presence of whitish exudate and width of lesions were significantly associated with severity of gastro-oesophageal reflux. Median fraction of the recording period with pH <4 was 5.9% in patients with narrow red lesions, 12.5% in patients with narrow, whitish lesions, and 20.3% in patients with broad lesions (P < 0.0001). The mean duration of reflux episodes was significantly longer and the number of nocturnal episodes lasting more than 5 min was significantly higher in patients with broad lesions. Conclusion: Red spats and streaks, even without whitish exudate, are significantly related to pathologic gastro-oesophageal reflux. Whitish exudate is related to more severe reflux, and broad lesions to a longer mean duration of the episodes. The presence of whitish exudate in lesions and the width of the lesions are important observations to use in the classification of reflux oesophagitis.