Endoscopic Reflux Esophagitis
 (Mucosal Disruption) 
Modified Savary-Miller Criteria

Erosive Esophagitis is observed in only about 50% of patients with GERD.  To increase the diagnostic accuracy of upper endoscopy in identifying GERD, special attention should be paid to the lower esophageal sphincter - for LESC - and the Larynx - for RL.  You can refer to the following studies for more in-depth information on endoscopic findings in patients with GERD.

• Omeprazole’s Efficacy in Patients with Intractable Erosive Esophagitis
• H2-Receptor Antagonists’ Effectiveness in Patients with Reflex Related Erosive Esophagitis (A Long Term Clinical Study)
• Clinical Endoscopic and Pathologic Manifestations of Bile Reflux Esophagitis
• Improving Diagnostic Accuracy of Upper GI Endoscopy in Patients with GERD

In classifying Erosive Esophagitis, the recent emergence of Los Angeles Criteria holds the promise of more consistent, and hence reproducible, grading.

Normal LES

 

Incompetent LES (LESC)

Hiatus Hernia

Grade I
Single or multiple erosions on a single fold

Grade II
Single or multiple erosions on multiple folds

Grade III
Confluent mucosal denudation and friability of distal esophagus

Grade IV
Presence of inflammatory stricture, deep ulcer or Barrett's Esophagus

                            Grade IV                                  Barrett's