Gastroesophageal Reflux, Slight Esophagitis vs. Gastroesophageal Reflux, Severe Esophagitis
Left picture: Here, a slight type of esophagitis is present. In case of clinically complicated reflux a biopsy is neccessary in any case if the mucous membrane seems normal; in single cases the esophagitis may be recognizable only by histology. Also, grading of the esophagitis is only reliable by biopsy. Right picture: According to the history, the encountered severe esophagitis is not due an incidental ingestion of a caustic substance. Rather, it is a severe type of a reflux esophagitis. The permanently open cardia with the immovable borders reminds of a cicatrization of the distal esophagus.
Photographs of the inside of the esophagus of two patients in whom an esophagoscopy has been performed due to hematin vomiting. Left picture: The distal esophagus in the picture does not allow to look in the stomach. At 12 to 1 and at 6 to 7 o´clock reddened zones are visible. Right picture: The transition from the distal esophagus to the stomach is constantly gapping. From 3 over 6 to 9 o´clock a white to yellowish coat with irregular borders is recognizable instead of a normal mucous membrane which is detached somewhat anteriorly from 12 to 3 o´clock. The findings are compatible with a severe corrosive ingestion.