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