In response to exposure to stomach acid, the lining of the esophagus often becomes red and inflamed. When these inflammatory changes become severe they can cause ulcerations and bleeding. The picture shown here is of an esophagus with Grade 2 esophagitis with several linear ulcerations due to reflux acid exposure.
In about 10% of patients with chronic GERD, the lining of the lower esophagus actually undergoes a change that makes it look more like the lining of the stomach. This condition is called Barrett's Esophagus and is associated with an increased risk of esophageal cancer. The only way to diagnose Barrett's is by direct inspection with an endoscope where a biopsy can be performed.
The stomach is normally found below the diaphragm, but if the opening in the diaphragm becomes stretched, a portion of the stomach can bulge up through the opening, and into the chest. This is called a hiatal hernia, and is one of the more common causes of acid reflux and chest pain.
A variety of conditions can be diagnosed using an endoscope, including inflammation, strictures, and other abnormalities of the esophagus. Likewise, inflammation, ulcers, and tumor growths can be identified in the stomach and duodenum, and biopsies are used to confirm any suspected diagnosis.
Perhaps the single most important tool available for the evaluation of the esophagus and stomach is the upper GI endoscope. It provides a high definition image of the entire esophagus, stomach and even part of the small intestine. The procedure carries a very low risk, and offers the endoscopist the means to perform biopsies of the lining of each of these organs. An endoscopy, also called an EGD, is an essential part of any comprehensive evaluation of a patient suspected of having acid reflux or GERD.
This test is typically performed in the hospital, or an endoscopy center, because it requires the use of intravenous sedation. The scope is a little less than a half inch in diameter and is placed into the body through the mouth. Patients are able to go home immediately after an EGD, but they will need someone to drive them due to the lingering effects of the sedation