The Road to Diagnosis: Decoding Your Medical Reports

When lifestyle changes and medication trials aren’t enough, doctors turn to specialized tests to “prove” the presence of GERD and rule out other conditions. Understanding the terminology in your medical reports can help you feel more confident in your diagnostic journey.

The Diagnostic Path

The journey usually begins with a trial of Proton Pump Inhibitors (PPIs). If your symptoms do not resolve, or if you have “alarm symptoms” (like difficulty swallowing), your doctor will recommend an Endoscopy (EGD) ^[1].

If the endoscopy is inconclusive—meaning your esophagus looks healthy but you still feel sick—the next step is often objective reflux testing, such as 96-hour wireless pH monitoring (Bravo). This involves a small capsule temporarily attached to your esophagus that measures acid levels for four days, capturing a broader picture of your symptoms than older 24-hour tests ^[2][3].

Important note for patients: This test is typically performed “off-medication.” You will usually need to stop your acid-blocking drugs for several days before and during the test to get an accurate baseline, so be mentally and physically prepared for a temporary flare-up of your symptoms.

Decoding Your Endoscopy Report

During an endoscopy, the doctor looks for specific physical markers. If your report contains these terms, here is what they mean:

1. LA Classification (Erosive Esophagitis)

This system grades the severity of “breaks” or erosions in the esophageal lining caused by acid.

• Grade A: Small erosions (less than 5mm).
• Grade B: At least one erosion longer than 5mm. While the 2022 ACG guidelines recognize Grade B as strong evidence of GERD, the globally adopted Lyon Consensus (2023) considers it “borderline.” This means you may still need additional pH testing to definitively prove GERD before considering surgery ^[2].
• Grades C & D: Large erosions that merge together or cover significant portions of the esophagus. These are universally recognized as definitive signs of severe reflux ^[4][5].

2. Hill Flap-Valve Grade (The Hernia Check)

The Hill Grade (I-IV) assesses the mechanical integrity of the “flap-valve” at the entrance to your stomach.

• Grades I and II: Considered normal mechanical function ^[6].
• Grades III and IV: Indicate the valve is loose or shifted, often signifying a hiatal hernia and a higher risk of persistent reflux ^[7].

3. Prague Classification (Barrett’s Esophagus)

If your doctor suspects Barrett’s esophagus (a change in the lining of the esophagus), they use the Prague system to measure it ^[8]:

• C (Circumferential): The height of the “ring” of changed tissue.
• M (Maximum): The total length of the longest “tongue” of changed tissue.

Advanced Testing: Manometry and FLIP

If your doctor needs to see how your esophagus moves rather than just how it looks, they may use:

• High-Resolution Manometry (HRM): A thin tube that measures the pressure and coordination of your esophageal muscles as you swallow. It is the “gold standard” for diagnosing movement (motility) disorders ^[9][10].
• FLIP (Functional Lumen Imaging Probe): Often done while you are sedated, this uses a balloon to measure how stretchy or stiff your esophagus and its valves are. It helps find blockages or muscle issues that manometry might miss ^[11][12].

Your Endoscopy “Completeness Checklist”

When you receive your report, ensure it addresses these four key areas:

1. LA Grade: Is it A, B, C, or D? ^[2]
2. Hill Grade: Is there a hiatal hernia, and how severe is the valve failure? ^[6]
3. Biopsies: Were samples taken to rule out Eosinophilic Esophagitis (EoE) or Barrett’s? ^[13]
4. Prague Score: If Barrett’s is suspected, are the ‘C’ and ‘M’ values recorded? ^[1]