Minimal changes in reflux esophagitis: red ones and white ones

Minimal change esophagitis is commonly accepted as part of the spectrum of reflux esophagitis in Japan as well as in many reflux esophagitis classification systems. However, the Los Angeles system excludes minimal changes as a sign of reflux esophagitis because of low interobserver agreement. The high prevalence of minimal change esophagitis suggests that many endoscopists can recognize such findings in their patients' esophagi. However, we do not have a clear definition of minimal changes, which requires proven interobserver agreement, histological evidence, and response data to therapeutic intervention. Furthermore, erythematous changes (red ones) and acanthotic changes (white ones) are not distinguished in the definition of minimal change used in Japan. It is time to clarify such issues.