Types/Grades (Gastroesophageal Reflux =Reflux, Hiatus Hernia)

Drawings of normal and of different pathoanatomical findings in gastroesophageal reflux (no. 1 and no. 2 through 5, M. Bettex). 1: Normal anatomical findings of the stomach and the gastroesophageal transition zone in relation to the left dome of diaphragm and esophageal hiatus. In 2 the angle of His is obtuse and from 3 on transiently or permanently parts of the stomach lie above the diaphragm to a different degree. One possible classification of the gastroesophageal reflux using pathoanatomical criteria differentiates between an isolated reflux without permanent herniation of parts of the stomach into the thorax (no. 2 and 3 = minor types of reflux), and a reflux combined with a hiatus hernia (no. 4, 5 and 6 = major types of reflux). In no. 2 the findings are minimal, and in no. 3 a transient epiphrenic gastric pouch may be seen on fluoroscopy. In some cases of reflux the obtuse angle of His is missing or not even a reflux of contrast can be seen in fluoroscopy. From 4 on the epiphrenic pouch is permanently present; in 5 the pouch is large, and in 6 nearly the whole stomach is within the thorax = upside-down stomach.