Abstract
The modified LA classification, including the minimum change (white mucosa and redness), is widely used to diagnose reflux esophagitis in Japan. One of the most important considerations in diagnosing an esophageal mucosal break is observing the lower esophagus, which is extended by inserting air into it after a deep inspiration. The diagnostic concordance rate for a mucosal break is high; however, the diagnostic concordance rate for a minimum change is low. This is the reason that there is neither a standardized evaluating system nor a definition of minimum change (obscure erythema, whitish mucosa). A standardized definition of minimum change should be determined in the near future.
Reflux esophagitis is caused by excessive esophageal exposure to acid. Therefore, in order to cure this disease, it is necessary to normalize excessive esophageal exposure to acid. In the guidelines for GERD by the Japanese Society of Gastroenterology, a standard-dose proton pump inhibitor (PPI) is recommended as the first-line therapy. The response rate to a standard dose of PPI among patients with mild reflux esophagitis is 90-95% and that among patients with severe reflux esophagitis is 80-85%. Should the standard dose of PPI not be effective, changing to another PPI and/or the method of administration (i.e., before a meal) might be effective.
