title: Difference in localization of esophageal mucosal breaks among grades of esophagitis.
abstract: BACKGROUND
  Gastroesophageal reflux occurs mainly during the daytime in patients with Los Angeles grade A esophagitis, but predominantly during the night in patients with grade C and D esophagitis. The purpose of the present paper was to investigate whether this difference in the pattern of gastroesophageal reflux influences the circumferential localization of erosions in the esophageal wall.
  
  
  METHODS
  The subjects were 394 consecutive patients diagnosed endoscopically as having reflux esophagitis (grade A, n = 223; B, n = 93; C, n = 53; D, n = 25 cases). Their endoscopic films were reviewed retrospectively to determine the circumferential location of esophageal mucosal breaks, and also the prevalence and size of hiatal hernia (HH).
  
  
  RESULTS
  The numbers of mucosal breaks analyzed in patients with grade A, B and C esophagitis were 321, 173 and 54, respectively. Patients with grade A and B esophagitis had longitudinal mucosal breaks mainly in the right-anterior wall of the lower esophagus, whereas patients with grade C esophagitis had transverse mucosal breaks mainly in the posterior wall. The prevalence and size of HH was significantly higher and larger, respectively, in patients with grade C or D esophagitis than in those with grade A and B esophagitis.
  
  
  CONCLUSIONS
  The circumferential location of esophageal mucosal breaks differs significantly among different grades of esophagitis.
authors.affiliation: Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Katsube
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Adachi
authors.forename: Kenji
authors.initials: K
authors.lastname: Furuta
authors.forename: Masaharu
authors.initials: M
authors.lastname: Miki
authors.forename: Tomoo
authors.initials: T
authors.lastname: Fujisawa
authors.forename: Takane
authors.initials: T
authors.lastname: Azumi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kushiyama
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kazumori
authors.forename: Shunji
authors.initials: S
authors.lastname: Ishihara
authors.forename: Yuji
authors.initials: Y
authors.lastname: Amano
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kinoshita
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D004941:Esophagitis / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000473:pathology*; D006551:Hernia, Hiatal / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology*; D015995:Prevalence; D018709:Statistics, Nonparametric