The classification of GERD severity of the disease
Classification of GERD
In therapy, a lot depends on the stages of the disease. This information affects the duration of treatment and the choice of certain drugs. In the case of the GERD in the first place matter how deeply affected esophageal mucosa. In medicine most used classification of gastroesophageal reflux disease which can be detected by this method of study as EGD (fibrogastroduodenoscopy).
What are the symptoms will bother humans at every stage of the disease? Now have to respond not only to this question. There are several classifications of GERD, consider the most common of them.
Classification of GERD was done according to ICD-10
The simplest classification is spelled out in one of the classic medical books called ICD-10 (international classification of diseases, tenth revision). Here is a clinical variant of division of GERD following.
- GERD with esophagitis (inflammation of the mucous membrane of the esophagus) — code according to ICD-10: K-21,0.
- GERD without signs of esophagitis — code according to ICD-10: K and 21.9.
Endoscopic classification of GERD
The endoscopic classification was proposed in the late 80-ies of Savary and Miller, and is widely used nowadays.
It has long been known that the mechanism of development GERD is a dysfunction of nippising sphincter (the muscle located on the border between the esophagus and the stomach, limiting the reverse movement of food). When this muscle is weakened, there is a reflux of gastric contents, including hydrochloric acid, into the esophagus. And over time, almost all of his sheath undergo changes. So they formed the basis for this classification.
In detail it can be summarized as follows.
- The first stage. Last esophagus, the one that is closer to the stomach, there are areas of erythema (redness of the mucosa due to capillary dilation), the possible erosion of individual (place of the mucous membrane with defects in the tissue). In some advanced cases of the disease, such changes may not be, and the diagnosis is based either on symptoms or when no other methods of study.
- In the second stage endoscopic classification of GERD erosion already takes about 20 % of the circumference of the esophagus. Under these lesions on the first place among the manifestations of the disease beyond heartburn.
- The third stage of the disease process is characterized by lesions not only the mucous layer of the esophagus and lower esophageal sphincter in the form of erosions. Here already there are ulcers that affect the muscle layer of the body. Such alterations occupy more than half the circumference of the esophagus. Person, while concerned about the burning sensation, chest pain, night symptoms overlap.
- In the presence of the fourth stage of the disease, thanks to EGD, you can see that the entire mucosa is damaged, the defects occupy almost 100% of the circumference of the esophagus. Clinically, at this stage of lesion, the person may experience the symptoms characteristic of this disease.
- The last of the fifth and the most unfavorable is the stage of development of complications. Revealed narrowing and shortening of the esophagus, deep, bleeding ulcer, Barrett’s esophagus (replacement of parts of the mucous membrane of the intestinal epithelium division).
Some authors of the last two stages combined into one.
In my practice, gastroenterologists often use the endoscopic classification to define the stages in the development of GERD. Her more often resorted therapists, considering it more simple to understand and comprehensive. But this is not the only division of GERD.
The Los Angeles classification of GERD
At the end of the 20th century at the European week of gastroenterology suggested to use the degree of prevalence of lesions. So there was the Los Angeles classification of GERD. Here’s what it involves.
- The severity of A — a one or more mucosal lesions of the esophagus (erosions or ulcers), each of which not more than 5 mm within only one of the folds of the mucous membrane.
- Degree B — the changes apply too, just one fold, but one of the lesions can extend beyond 5 mm.
- Degree C — the process has already been spread to 2 folds or more, regions with changes of more than 5 mm. At this stage the lesions of the esophagus reaches 75%.
- The degree D is a big part of the esophagus affected. Around the circumference of the lesion be at least 75%.
According to the Los Angeles classification complications such as ulcers and constrictions may be present on any of the above stages.
Units at the stage of development of the disease was created to simplify the work of doctors. Through the classifications, it becomes easier to understand the manifestation process and to find better methods of treatment. To establish at what stage of the disease is a every people suffering from GERD, can be a doctor. Therefore, at the first sign of illness, speed recovery, contact the experts.