Edema of the esophageal mucosa causes loss of this fine vascular pattern and the squamocolumnar junction becomes indistinct. Friable areas may be associated with red streaks, which usually appear on the tops of the mucosal folds extending up from the squamocolumnar junction. These findings are less subject to observer variation and are the earliest signs of esophagitis. Grade II esophagitis. Erosions represent thinning of the superficial epithelium and appear as whitish exudates surrounded by red halos of erythema.
Erosions are typically contiguous with or appear just above the squamocolumnar junction.
Single erosions are usually seen along the tops of the mucosal folds. As the disease becomes more severe, isolated erosions may coalesce and bridge adjacent folds. Grade III esophagitis. The most severe damage to the esophagus produces ulcers that have some depth, a white or yellow base, and are variable in size and shape. Most patients with grade III esophagitis will have some complications of GERD, particular strictures, or Barrett's esophagus.