[Reflux disease of the esophagus]

An attempt is made to correlate clinical respectively endoscopic and histomorphological findings in patients with gastroesophageal reflux disease. The histological stage Ia cannot be identified endoscopically. However, certain correlations can be found between endoscopic stage I (the "red spot") on the one hand and the histological stage Ib (hyperemic capillaries) on the other, just as well as between subsequent endoscopical and histological stages. The histomorphological stage IV corresponds to the clinical stage IV and represents the ultimate complication of the reflux disease, esophageal stenosis caused by ulceration plus endobrachyesophagus. In this stage no restitutio ad integrum is possible anymore. The initial changes of the gastroesophageal reflux disease occur within the epithelium and the papillae and can be recognized microscopically in biopsies taken during endoscopy. Changes in the submucosal layer are of no importance during the early reversible stages. The lining of the endobrachyoesophagus with cylindrical epithelium ("Barrett mucosa") is probably the consequence of reflux. This type of lining presents an irregular picture from the morphological as well as from the clinical point of view and is to be considered as a pre-stage of adenocarcinoma of the esophagus.