Grading classification of reflux esophagitis

    Hetzel Dent classification

    •Grade 0: Normal mucosa, no abnormalities found

    •Grade 1: No macroscopic erosions, but presence of erythema, hyperemia, and/or friability of the esophageal mucosa

    •Grade 2: Superficial ulceration or erosions involving less than 10% of the mucosal surface area of the last 5 cm of esophageal squamous mucosa

    •Grade 3: Superficial ulceration or erosions involving greater than or equal to 10% but less than 50% of the mucosal surface area of the last 5 cm of esophageal squamous mucosa

    •Grade 4: Deep ulceration anywhere in the esophagus or confluent erosion of more than 50% of the mucosal surface area of the last 5 cm of esophageal squamous mucosa

    •Grade 5: Stricture, defined as a narrowing of the esophagus that does not allow easy passage of the endoscope without dilatation

    Grade N: No minimal change and no mucosal break

    Grade M: Minimal change without mucosal break

    Grade A: One (or more) mucosal break no longer than 5mm, that does not extend between the tops of two mucosal folds

    Grade B: One (or more) mucosal break more than 5mm long that does not extend between the tops of two mucosal folds

    Grade C: One (or more) mucosal break that is continuous between the tops of two or more mucosal folds but which involves < 75% of the circumference

    Grade D: One (or more) mucosal break which involves ≥ 75% of the esophageal circumference

     

    Initial Management

    • Esophageal biopsies: rule out other conditions in the differential diagnosis, such as eosinophilic esophagitis, Crohn’s disease, Barrett esophagus, infection and others

    • Treatment:

    - PPI: esomeprazole, lansoparzole….

    - Baclofen: prior to surgery

    - Surgery

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