Gastroesophageal Reflux Disease: Classification

During esophagogastroduodenoscopy (gastroscopy), gastroesophageal reflux disease can be classified as follows based on the extent of lesions (tissue lesions) found:

The disease stages of reflux esophagitis are divided into four stages according to Savary and Miller:

Stage Description
0 No mucosal changes
I One or more nonconfluent mucosal lesions with redness and exudation
II Confluent erosive and exudative lesions that do not yet occupy the entire circumference (lat.: circumference) of the esophagus (food pipe)

  • Superficial erosion (red spots).
  • Deep erosions with fibrinoid necrosis (red spots with whitish center).
III The lesion occupies the entire circumference of the esophagus
IV Complications: Esophageal ulcer (oesophageal ulcer), Barrett’s esophagus, strictures (high-grade narrowing), and other chronic mucosal lesions

  • IVa: Cylinder epithelial metaplasia with or without ulcers (ulcers).
  • IVb: Cicatricial stricture with stenosis (narrowing).

The Los-Angeles classification takes into account the endoscopic extent of the defects and divides them into four stages (A-D):

Stage Mucosal lesions (mucosal defects)
A In distal (“lower”) esophagus, ≤ 5 mm.
B In distal esophagus, > 5 mm
C Confluent (“flowing together”), ≤ 75% of the circumference of the esophagus
D Confluent, 75% of the circumference of the esophagus.

The Los Angeles classification is the only one evaluated in numerous studies.The MUSE classification distinguishes the four endoscopically assessable formations:

Metaplasia
Ulcer
Stricture
Erosion

The four criteria are described as follows: 0 = absent; 1 = minor; 2 = moderate; 3 = severe. Although the Muse classification is the most accurate, it is also the most unwieldy classification in everyday use.