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Electronic Endoscopy and Biopsy Findings During the Course of Reflux Esophagitis
Author(s) -
TOKI Munetoshi,
OHWADA Tsuneo,
SEKIGUCHI Toshikazu
Publication year - 1991
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.1991.tb00513.x
Subject(s) - medicine , esophagitis , esophagus , gastroenterology , reflux esophagitis , hiatal hernia , endoscopy , reflux , biopsy , muscularis mucosae , stage (stratigraphy) , disease , paleontology , biology
We observed the esophageal mucosa in 90 patients with reflux, esophagitis using a zoom‐type electronic endoscope and clarified the endoscopic characteristics of each stage of the disease as well as the response to treatment. It was possible to differentiate between white slough, erosions and regenerating epithelium from observations of the magnified mucosa. The white slough appeared uniform and featureless, the erosions appeared irregular and had featureless reddish areas, and regenerating epithelium were noted in the reddish areas in addition to various types of mucosal surface structure. Biopsies obtained after the disappearance of the white sloughs of reflux esophagitis from the mucosal membrane of the discolored esophagitis generally showed the “accessory findings” of the diagnostic criteria of the Japanese Society of Esophageal Diseases. Even in the early scarring stage (S1), the inflammation persisted under the regenerating mucosa, and it was necessary to continue treatment until the late scarring stage (S2) to prevent recurrence. Regarding treatment, H 2 receptor antagonists were effective, but 19.4% of the patients showed resistance to them. Intractable esophagitis was often seen in stage III and IV of the Savary & Miller classification and in the elderly patients. Intractable esophagitis was associated with a high incidence of hiatus hernia, a reduced lower esophageal sphincter pressure, and a reduction in primary peristalsis in the lower esophagus.