Esophagitis is an inflammation of the esophagus, the tube connecting your mouth to your stomach. The severity of esophagitis is often categorized based on endoscopic findings.
Understanding Grade B Esophagitis
The Los Angeles (LA) Classification system grades the severity of reflux esophagitis based on endoscopic assessment. This system categorizes mucosal breaks in the esophageal lining. The LA classification divides esophagitis into four grades, from A to D, with increasing severity.
Grade B esophagitis indicates the presence of one or several mucosal breaks longer than 5 millimeters. These breaks do not extend continuously between the tops of two mucosal folds, meaning they haven’t circumferentially affected a significant portion of the esophageal lining.
In contrast, Grade A involves breaks no longer than 5 mm. Grades C and D represent more widespread damage: Grade C involves mucosal breaks continuous between two or more mucosal folds but affecting less than 75% of the esophageal circumference. Grade D, the most severe, features confluent erosions extending over 75% or more of the esophageal circumference. While Grade B is more extensive than Grade A, it is generally considered a moderate form of esophagitis, often manageable with appropriate treatment leading to healing.
Potential Complications
If Grade B esophagitis remains untreated or is poorly managed, ongoing inflammation can lead to complications.
One potential complication is esophageal strictures, narrowings of the esophagus. This occurs when chronic inflammation leads to scarring and fibrous tissue buildup in the esophageal wall. Strictures can make swallowing difficult and may require endoscopic dilation to open the narrowed area.
Another possible issue is the development of esophageal ulcers. These are deeper erosions that penetrate beyond the superficial mucosal layer, potentially causing bleeding. Ulcers can result in pain, difficulty swallowing, and blood loss requiring medical intervention.
Another complication, though less common, is Barrett’s esophagus. This condition involves a change in the cells lining the lower esophagus, where the normal squamous cells are replaced by columnar cells, similar to those found in the intestine. While Grade B esophagitis itself is not cancerous, chronic inflammation can predispose individuals to this cellular change, which carries a very low risk of progressing to esophageal cancer.
Treatment and Management
Treatment for Grade B esophagitis typically involves lifestyle adjustments and medication to reduce stomach acid and promote healing. These approaches aim to minimize the reflux that causes the inflammation and allow the esophageal tissue to recover.
Lifestyle modifications reduce symptoms and prevent further damage. This includes avoiding trigger foods such as fatty meals, spicy dishes, citrus, chocolate, and caffeine. Elevating the head of the bed during sleep can help prevent acid from flowing back into the esophagus, and losing weight if overweight can also alleviate pressure on the stomach. Avoiding late-night meals, quitting smoking, and reducing alcohol intake are additional steps that can contribute to symptom improvement and healing.
Medications are a primary treatment for Grade B esophagitis. Proton pump inhibitors (PPIs) are commonly prescribed as they effectively reduce the production of stomach acid, allowing the esophageal lining to heal. H2 blockers are another class of medication that can reduce acid secretion and may be used as an alternative or in conjunction with PPIs.
Endoscopic procedures are generally not required for Grade B esophagitis itself. However, if complications such as strictures or significant ulcers develop, an endoscopy may be performed to address these specific issues, for example, to dilate a stricture or treat a bleeding ulcer. With proper treatment and consistent management, Grade B esophagitis often heals, and symptoms can significantly improve.