Upper GI Endoscopy Results: Key Findings and Recommendations

Q: Upper GI Endoscopy Results: Key Findings and Recommendations

The grading of gastroesophageal reflux disease (GERD) can be somewhat subjective and may vary between physicians. <br>The principle of treatment is to control symptoms with proton pump inhibitors (PPIs) such as Nexium. <br>If there is no Helicobacter pylori infection, antibiotics

Upper gastrointestinal endoscopy results?

[First Endoscopy Findings]: (Esophagus): Mucosal break at the esophagogastric junction less than 5mm.
(Stomach): CLO test was performed.
Hyperemic mucosal changes at the antrum, shallow gastric ulcer at the antrum, s/p.
(Duodenum): Narrowing of the lumen at the inferior duodenal angle, suspected external compression related, cause? (Diagnosis): 1.
Reflux Esophagitis, LA Grade (A) (No Biopsy) 2.
Superficial Gastritis (No Biopsy) 3.
Gastric Ulcer (Biopsy was done) Others: Narrowing of the lumen at the inferior duodenal angle, suspected external compression related, cause? (Suggestions): PPI treatment pending pathology report / GI OPD follow-up (Biopsy examination).
The specimen submitted consists of a tissue fragment measuring 0.2 x 0.1 x 0.1 cm, fixed in formalin.
Grossly, it is tan and elastic.
All for section.
Microscopically, the sections show a picture of chronic gastritis.
No evidence of malignancy.
Checklist of gastritis: 1.
Neutrophils activity: Absent.
2.
Chronic inflammation/Mononuclear cells infiltration: Mild.
3.
Atrophy of glands: Absent.
4.
Intestinal metaplasia: Absent.
5.
Helicobacter-like microorganism: Not identified.

[Second Endoscopy Findings]: (Esophagus): Sliding hiatal hernia with mucosal breaks at L/3 > 5 mm with confluence < 75% circumference.
(Stomach): Gastric shallow ulcers, H1 s/p biopsy x 2 for pathology.
Hyperemia noted at the antrum; CLO test was done in the prepyloric area.
(Duodenum): Negative for bulb and second portion.
[Diagnosis]: 1.
GERD Grade C with hiatal hernia, rule out hoase shade gastric type.
2.
Esophagogastric junction s/p adhesion relaxation gastritis, antrum.
3.
Gastric multiple round ulcers, H1 s/p biopsy x 2 for pathology with hematin.
4.
Duodenitis.
[Recommendation]: 1.
PPI treatment, RAC treatment if positive CLO test.
2.
GI OPD follow-up.
I would like to ask the doctor, after the first endoscopy, I have been taking Nexium Tab 40mg for one month and Pariet EFC Tab 20 mg for half a month! However, the results from the second endoscopy changed from GERD Grade A to Grade C.
Should I be concerned about anything else? Additionally, I would like to inquire about the significance of "hoase shade gastric type." Does RAC treatment refer to antibiotic therapy?

LEO, 20~29 year old female. Ask Date: 2023/03/01

Dr. Chen Shidian reply Gastroenterology and Hepatology

The grading of gastroesophageal reflux disease (GERD) can be somewhat subjective and may vary between physicians.
The principle of treatment is to control symptoms with proton pump inhibitors (PPIs) such as Nexium.
If there is no Helicobacter pylori infection, antibiotics are not necessary.
It is also advisable to discuss and consult with the attending physician.

Reply Date: 2023/03/01

More Info

Based on the findings from your upper GI endoscopy reports, it appears that you have been diagnosed with several gastrointestinal conditions, including gastroesophageal reflux disease (GERD), superficial gastritis, and gastric ulcers. The progression from GERD Grade A to Grade C indicates a worsening of your condition, which is concerning and warrants further attention.

Understanding Your Diagnosis
1. GERD (Gastroesophageal Reflux Disease): GERD is characterized by the backflow of stomach contents into the esophagus, leading to symptoms such as heartburn and regurgitation. The grading system (LA classification) ranges from A (mild) to D (severe), with Grade C indicating more significant esophageal damage. The presence of mucosal breaks greater than 5 mm suggests that the reflux has caused more severe inflammation and damage to the esophagus.

2. Superficial Gastritis: This condition involves inflammation of the stomach lining. The biopsy results showing chronic gastritis without malignancy are reassuring, but it indicates that your stomach lining is inflamed, which can contribute to discomfort and ulcers.

3. Gastric Ulcers: The presence of multiple round ulcers in the stomach, especially with a history of H. pylori infection (indicated by the CLO test), requires careful management. The biopsy results will help determine if the ulcers are related to H. pylori, which is a common cause of gastric ulcers.

4. Duodenitis: Inflammation of the duodenum can occur due to various factors, including reflux of gastric contents. The narrowing of the lumen at the inferior duodenal angle may suggest external compression, which could be due to anatomical changes or other underlying conditions.

Recommendations and Treatment
1. PPI Treatment: You are currently on proton pump inhibitors (PPIs) like Nexium (esomeprazole) and Pariet (rabeprazole), which are effective in reducing stomach acid and promoting healing of the esophagus and stomach lining. Continuing this treatment is essential, especially given the progression of your GERD.

2. Follow-Up: Regular follow-up with a gastroenterologist is crucial. They may recommend further endoscopic evaluations or imaging studies to monitor the healing of your esophagus and stomach, especially after the biopsy results are available.

3. RAC Treatment: The term "RAC tx" likely refers to the treatment for H. pylori infection, which typically involves a combination of antibiotics and PPIs. If your CLO test is positive, this treatment will be necessary to eradicate the bacteria and promote healing of the gastric ulcers.

4. Lifestyle Modifications: In addition to medication, consider lifestyle changes such as dietary modifications (avoiding spicy, acidic, or fatty foods), weight management, and elevating the head of your bed to reduce nighttime reflux.

Clarifications
- Hoase Shade Gastal Type: This term is not commonly used in medical literature. It may be a typographical error or a specific term used by your physician. It would be best to clarify this with your gastroenterologist for an accurate understanding.

- Monitoring: Given the progression of your GERD and the presence of gastric ulcers, it is vital to monitor your symptoms closely. If you experience worsening symptoms such as significant pain, difficulty swallowing, or gastrointestinal bleeding, seek immediate medical attention.

In summary, your condition requires careful management and monitoring. Continue your prescribed medications, follow up with your healthcare provider, and consider lifestyle changes to help manage your symptoms effectively. If you have further questions or concerns, do not hesitate to reach out to your gastroenterologist for personalized advice and treatment options.

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