John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
In this Article
- Facts and definition of esophagitis
- What is esophagitis?
- What are the signs and symptoms of esophagitis?
- What are the types of esophagitis?
- What causes esophagitis?
- What are the grades of esophagitis?
- Which specialties of doctors treat esophagitis?
- How is esophagitis diagnosed?
- What is the treatment for esophagitis?
- What about esophagitis and diet?
- What options are there for pain relief for esophagitis?
- What are the complications of esophagitis?
- Can esophagitis be prevented?
- What is the prognosis for a person with esophagitis?
- Find a local Gastroenterologist in your town
What are the grades of esophagitis?
There are number of grading systems used to evaluate the severity of the disease. Savary-Miller and the Los Angeles Classification System are two of the commonly used grading systems.
- Grade I: one or more supravestibular, non-confluent reddish spots, with or without exudate
- Grade II: erosive and exudative lesions in the distal esophagus which may be confluent, but not circumferential
- Grade III: circumferential erosions in the distal esophagus, covered by hemorrhagic and pseudomembranous exudates
- Grade IV: presence of chronic complications such as deep ulcers, stenosis, or scarring with Barrett's metaplasia
Los Angeles Classification System grades reflux esophagitis:
- Grade A: One (or more) mucosal break no longer than 5 mm that does not extend between the tops of two mucosal folds
- Grade B: One (or more) mucosal break more than 5 mm 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 involve less than 75% of the circumference
- Grade D: One (or more) mucosal break which involves at least 75% of the esophageal circumference
Which specialties of doctors treat esophagitis?
A primary care provider (PCP) such as a family medicine specialist, an internist, or a child's pediatrician, may initially diagnose esophagitis. For further treatment you will likely be referred to a gastroenterologist, a specialist in disorders of the digestive system.
How is esophagitis diagnosed?
A gastroenterologist may order specialized tests to look for the cause and extent of the esophagitis. These tests include:
- Esophagogastroduodenoscopy (EGD): An endoscope is used to directly examine the esophagus, stomach and first part of the intestines. In addition, tissue samples can be obtained (biopsy) to assess the severity of the damage to the esophagus.
- Esophageal manometry: this test is used to measure the pressure inside the lower part of the esophagus. A thin, pressure-sensitive tube is passed through the mouth or nose and into the stomach, which is then pulled slowly back into the esophagus. Patients are asked to swallow, and the pressure of the muscle contractions is measured along several sections of the tube.
- Upper GI series or barium swallow is a test where X-rays are taken of the esophagus after drinking a barium solution. Barium coats the lining of the esophagus and appears white on an X-ray, and can show the location and extent of damage to the esophagus.
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