Patients with chronic GERD symptoms undergoing endoscopy have been studied by Winters and colleagues. In a report published in Gastroenterology in 1987, the authors found that of approximately 100 patients with longstanding or chronic GERD who had an upper endoscopy, 42% were normal, 45% demonstrated erosive esophagitis, and 12% had Barrett's esophagus. So, it is reassuring that more than 40% of patients were found to be normal; however, it is the other nearly 60% of patients who have a positive exam and may need further treatment.
The esophagus is a tubular structure that is about 20 to 25 centimeters (about 10 inches) long and is primarily made up of muscle. The inside of the tube is called the lumen, and it has a smooth lining called the mucosa, which is whitish in color. Below this is the junction between the esophagus and stomach where the mucosa changes in color and type. Stomach (gastric) mucosa is pink or salmon-colored and produces acid, among other things. At the bottom of the esophagus is the lower esophageal sphincter, or LES. The LES is a circular muscle located within the wall of the esophagus and closes to prevent reflux of material up from the stomach into the esophagus.
In an endoscopy, the scope travels down through the lumen of the esophagus to examine the mucosa. Irregularities easily can be seen and documented with photos or video and biopsies taken if needed. Esophagitis is inflammation of the esophageal mucosa caused by acid. Usually this occurs at the bottom near the stomach (gastric)-esophagus junction (called the GEJ). Esophagitis is graded on its severity and can range from mild, patchy redness of the mucosa to severe inflammation with loss of most of the esophageal mucosa with extensive ulceration.
Chronic acid damage of the lining can result in recurrent inflammation with replacement of the normal mucosa with an acid-resistant abnormal mucosa called Barrett's esophagus.
Chronic acid damage of the esophageal lining can result in recurrent inflammation with replacement of the normal mucosa with an acid-resistant abnormal mucosa called Barrett's esophagus. Endoscopically, this looks like tongues of salmon-colored mucosa extending from the gastroesophageal junction, GEJ, up into the esophagus. This area requires a biopsy to determine whether it has the microscopic features that confirm the diagnosis of Barrett's esophagus. Esophageal strictures or rings can be seen in patients with GERD, although generally these occur in patients with difficulty swallowing. Endoscopically, these range from a smooth, regular-appearing narrowing that easily allow passage of the scope, which is as wide as your pinkie, to a tight, ulcerated narrowing, which can be as small as a pinhole. These strictures can be biopsied, stretched, or dilated with or assisted by the endoscope. So, endoscopy is diagnostic and demonstrates whether a person has damage from chronic GERD, and it is therapeutic, allowing biopsy and treatment.
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.