Staging Scheme of Duranceau and Jamieson for the Severity of Gastroesophageal Reflux Disease

Parameter

Finding

Grade

endoscopic appearance

normal

0

erythema

1

erosions and ulceration

2

stricture or columnar-lined esophagus

3

histology

normal

0

basal cell hyperplasia

1

acute epithelial or subepithelial inflammation and/or ulceration

2

fibrosis or columnar-lined esophagus

3

manometry

normal motility and lower esophageal sphincter pressure > 10 mm Hg

0

normal motility and lower esophageal sphincter pressure 6-10 mm Hg

1

normal motility and lower esophageal sphincter pressure < 6 mm Hg

2

aperistaltic and lower esophageal sphincter pressure < 6 mm Hg

3

pH monitoring

no reflux of acid or < 4% of time

0

reflux 4-7% of time

1

reflux 7-12% of time

2

reflux > 12% of time

3

Findings

Stage

all 4 parameters Grade 0

0

maximum Grade 1

1

maximum Grade for endoscopy and histology Grade 1

manometry and pH Grades 2 or 3

2

all parameters Grades 2 or 3 but not Stage 4

3

stricture and/or esophagus lined by columnar epithelium

4