Endoscopy is indicated at first presentation for patients with alarm symptoms referable to the upper gastrointestinal tract. Thus, endoscopy is not the final arbiter as to a diagnosis of reflux disease, and it is not, therefore, a necessary prerequisite to therapy. Endoscopy is not universally applicable: 40 to 60 percent of patients with typical reflux symptoms do not have esophageal erosions and are now considered to have "endoscopy negative reflux disease" (ENRD). Thus, for patients with "complicated" reflux disease, the "MUSE" classification offers a more comprehensive description of esophagitis severity. The "L.A." (Los Angeles) classification describes four grades of esophagitis severity (A to D), based on the extent of esophageal lesions known as "mucosal breaks," but it does not record the presence or severity of other GERD lesions. Recent studies confirm that endoscopists can identify erosions or mucosal breaks, ulcers, strictures, and metaplasia reproducibly. The "MUSE" (metaplasia, ulceration, stricturing and erosions ) classification provides clear definitions of the relevant endoscopic features, and it is based on a standardized report form, which allows the endoscopist to make a clear record of esophagitis severity. The Savary-Miller endoscopic classification system is used widely but usage and interpretation are very variable. It is, therefore, important to grade the severity of erosive reflux esophagitis, particularly in the context of clinical trials. Erosion severity is predictive of a patient's response to therapy and of the likelihood of relapse after therapy.
Endoscopy is, currently, the initial investigation of choice for the investigation of gastroesophageal reflux disease (GERD) in clinical practice and clinical research.
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