Gastroesophageal reflux disease (GERD: types

Currently, many different classifications of gastroesophageal reflux disease have been proposed, but the Savilar-Miller classification is most interesting for practice.

Endoscopic classification of GERD by Savary and Miller (1978)

0 degree	GERD without esophagitis (endoscopically negative).
I degree	Individual inconspicuous erosion and / or erythema of the distal esophagus.
II degree	Fusing, but not engaging the entire surface of the mucous erosive lesions.
III degree	Ulcerous lesions of the lower third of the esophagus, merging and covering the entire surface of the mucosa.
IV degree	Chronic oesophageal ulcer, stenosis, Barrett's esophagus (cylindrical metaplasia of the esophagus mucosa).

That is, esophagoscopy is one of the main methods for assessing the severity of reflux esophagitis, but it does not make it possible to diagnose GERD in the early stages, in the absence of changes in the mucosa of the esophagus, and to estimate the frequency and duration of pathological casts.

In 1997, at the 6th European gastroenterological week, a new classification of gastroesophageal reflux disease was presented, based not on the degree of severity, but on the prevalence of the lesion (hyperemia, erosion, etc.). Moreover, complications of GERD (ulcer, stricture, Barrett's esophagus), according to the classification of Savary-Miller, belonging to the 4th degree, according to the Los Angeles classification can be present in the normal state of the mucosa or at any other stage of GERD.

• Degree A - lesion of the mucous membrane within the folds of the mucosa, while the size of each lesion site does not exceed 5 mm.
• Degree B - the size of at least one lesion site exceeds 5 mm; defeat within one fold, but does not connect two folds.
• Degree C - lesions of the mucosa are connected between the apices of two or more folds, but less than 75% of the circumference of the esophagus is involved in the process.
• Degree D - lesions cover at least 75% of the circumference of the esophagus.

In the endoscopically negative form of GERD, the main instrumental method to confirm the diagnosis is daily monitoring of the intraepithelial pH. This method allows not only to identify and evaluate the nature, duration and frequency of reflux, but also to select and evaluate the effectiveness of therapy.

When deciphering pH readings in the esophagus, the following parameters are evaluated:

• total time during which the pH takes values less than 4 units. This indicator is also estimated with the vertical and horizontal position of the body;
• the total number of refluxes per day;
• the number of refluxes lasting more than 5 minutes each;
• duration of the most prolonged reflux;
• esophageal clearance. This indicator is calculated as the ratio of the total time with a pH greater than 4 in the prone position to the total number of refluxes during this time, i.e. Equals the mean duration of reflux in the prone position. Esophageal clearance is calculated only for the period of prone to exclude the influence of gravity;
• reflux index. Calculated as the number of refluxes per hour for the period under study in the supine position, except for a period of time with a pH of less than 4.

At a pH-metric study under gastroesophageal reflux, it is customary to imply episodes in which the pH in the esophagus drops below 4.0 units. Normal values in the terminal section of the esophagus 6.0-8.0 units. Gastroesophageal reflux occurs in healthy people, but the duration of reflux should not exceed 5 minutes, and the total decrease in pH to 4.0 units. And below should not exceed 4.5% of the total recording time. Those. The presence of pathological reflux indicates:

• acidification of the esophagus, lasting more than 5 minutes;
• a pH reduction of less than 4 for a time exceeding 4.5% of the total recording time.

A reflux with a duration of 6-10 minutes, pronounced - exceeding 10 minutes, is considered moderate.

Normal pH-gram in the esophagus with 24-hour monitoring. On the pH-gram the average pH level in the esophagus ranges from 6.0 to 8.0, short-term physiological acid refluxes, mainly in the daytime, were recorded.

[1], [2], [3], [4], [5]