Endoscopic biopsy study for staging of reflux esophagitis

Endoscopy reveals that the lesions of reflux esophagitis are red and white spots and streaks. The red lesions are thought to reflect local inflammatory alterations with or without partial necrosis of the squamous epithelium, while white lesions represent complete necroses of the squamous epithelium with fibrin deposits. Fifty-nine patients with reflux esophagitis and red lesions (n = 23) or white lesions (n = 36) underwent endoscopically controlled biopsy of selected particles. Histologic analysis confirmed the hypothesis that white lesions are nearly always necroses involving all layers of the squamous epithelium with fibrin deposits (and rarely epithelial hyperplasia), while red lesions are caused by local granulocytic inflammation or granulation tissue with partial reepithelialization. These results suggest that reflux esophagitis Savary Stages I and II can be rationally subclassified into reflux esophagitis with red spots (Stage Ia), white spots (Stage Ib), red streaks (Stage IIa), and white streaks (Stage IIb).