Endoscopic evaluation of gastroesophageal sphincter dysfunction.

The introduction of modern endoscopes, light sources, and cameras has greatly improved the endoscopist's ability to diagnose and document the presence of reflux esophagitis. A reliable objective diagnosis of reflux esophagitis can be made in the presence of active erosion, friability, and ulceration. Reflux can be suspected in the presence of a patulous cardia. Gross reflux is uncommonly seen in the relaxed patient during endoscopy, but its presence is pathologic. The x-ray and endoscopic diagnosis of hiatal hernia correlate well. Endoscopists must be aware of those rare cases where an infectious cause for esophageal inflammation may be present. Although endoscopic biopsy and brush cytology are of limited value in the diagnosis of esophagitis, they permit an accurate differentiation between benign and malignant lesions in the esophagus and their use is encouraged in chronic cases of esophagitis where an increased risk of malignancy is present.