Hiatal hernia and gastroesophageal flap valve as diagnostic indicators in patients with gastroesophageal reflux disease.

摘要

When patients with heartburn or other reflux symptoms visit our clinic, the first diagnostic test generally performed after obtaining a complete medical history is an endoscopic examination of the upper gastrointestinal tract. When mucosal breaks on the lower esophageal mucosa are found endoscopically, a diagnosis of reflux esophagitis is established and treatment with acid suppressing drugs initiated, which has a high rate of success. When no mucosal breaks are found, a tentative diagnosis of nonerosive reflux disease (NERD) is made for symptomatic patients. Although no mucosal breaks may be evident, diffuse or undemarcated discoloration of the esophageal mucosa can be found in some cases of NERD. When patients have diffuse or undemarcated discoloration on the lower esophageal mucosa, they are endoscopically diagnosed as grade M (minimal change) esophagitis, according to the modified Los Angeles classification, while those with no such endoscopic abnormalities are classified as grade N (normal).