(Left) Graphic shows a small type 1 (sliding) hiatal hernia, associated with foreshortening of the esophagus, ulceration of the mucosa, and tapered stricture of the distal esophagus.
(Right) Film from an air-contrast esophagram demonstrates a small hiatal hernia , foreshortening of the esophagus, and a mild stricture at the gastroesophageal (GE) junction. There are several subtle esophageal ulcers at the level of the stricture.
(Left) Spot film from a barium esophagram shows a small hiatal hernia. Note the gastric folds extending above the diaphragm. The esophagus appears shortened, presumably due to spasm of the longitudinal muscles within its wall. A stricture is present at the GE junction, and persistent collections of barium indicate mucosal ulceration .
(Right) An esophagram in the same patient shows that a 13 mm barium-impregnated pill cannot pass through the peptic stricture.
TERMINOLOGY
Definitions
• Inflammation of esophageal mucosa due to gastroesophageal (GE) reflux
IMAGING
General Features
• Best diagnostic clue
Irregular ulcerated mucosa of distal esophagus on barium esophagram
Most common sign
– Finely nodular or granular appearance with poorly defined radiolucencies that fade peripherally due to edema and inflammation of mucosa
• Location
Distal 1/3 or 1/2 of esophagus
• Other general features
Complication of gastroesophageal reflux disease (GERD)
Based on onset, classified clinically and radiologically
– Acute or chronic reflux esophagitis
Severity of reflux esophagitis
– Depends on intrinsic resistance of mucosa
Radiographic Findings
• Double-contrast esophagography
Acute reflux esophagitis
– Decreased primary wave of peristalsis with increased tertiary contractions
– Mucosal nodularity
Fine nodular, granular, or discrete plaque-like defects (pseudomembranes)
– Foreshortening of esophagus
Due to spasm of longitudinal muscles
Not necessarily fibrotic stricture
– Ulcers
Single or multiple tiny collections of barium with surrounding mounds of edematous mucosa
Radiating and puckering of folds
Usually at or near GE junction
– Thickened vertical or transverse folds (> 3 mm)
Chronic or advanced reflux esophagitis
– Decreased distal esophageal distensibility with irregular, serrated contour (due to ulceration/edema/spasm)
Due to ulceration, edema, or spasm
– Sacculations and pseudodiverticula may be seen
– Peptic stricture (1-4 cm length/0.2-2 cm width)
Concentric smooth-tapered narrowing of distal esophagus with proximal (upstream) dilatation
Some may resemble Schatzki rings, but are generally thicker
– “Stepladder” appearance
Transverse folds due to vertical scarring
– Hiatal hernia
Seen in > 95% of patients with peptic stricture
Probably result and not cause of reflux
– Inflammatory pseudopolyp
Single enlarged fold arising at GE junction
No malignant potential but may need endoscopy with biopsy to rule out cancer
CT Findings
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, foreshortening of the esophagus, and a mild stricture at the gastroesophageal (GE) junction. There are several subtle esophageal ulcers 
at the level of the stricture.
extending above the diaphragm. The esophagus appears shortened, presumably due to spasm of the longitudinal muscles within its wall. A stricture is present at the GE junction, and persistent collections of barium indicate mucosal ulceration 
.
cannot pass through the peptic stricture.
