How does GERD appear on endoscopy?

• A. Erosive esophagitis with mucosal breaks; some patients have non-erosive reflux disease with normal endoscopy.
• B. Only Barrett's esophagus is seen.
• C. Endoscopy always shows ulcers.
• D. Endoscopy cannot detect GERD features.

Answer: (A)

Endoscopy can show a range of appearances in GERD. When there is actual injury from acid, you may see erosive esophagitis with mucosal breaks, edema, and erythema in the distal esophagus. But many patients have non-erosive reflux disease, where the endoscopy looks normal and there are no visible mucosal breaks. Barrett’s esophagus is another possible finding in chronic GERD, presenting as a change from squamous to columnar epithelium in the distal esophagus, but it isn’t seen in everyone and represents a complication rather than a universal appearance. Ulcers are not typical in uncomplicated GERD, and endoscopy can be normal even when reflux symptoms are present. Therefore, the best description is that GERD can appear as erosive esophagitis with mucosal breaks or as a normal endoscopic exam in non-erosive reflux disease.