Which of the following statements about pathology encountered at esophagoscopy is/are correct?

D. In patients with Barrett's mucosa, the squamocolumnar epithelial junction occurs 3 cm. or more proximal to the anatomic esophagogastric junction.

DISCUSSION: The traditional subjective grading of reflux esophagitis as mild, moderate, or severe has inherent wide variations in meaning among observers. Consistent use of standardized grading systems for endoscopic reflux esophagitis (e.g., that of Belsey or Savary) provides a more objective description of the changes seen and allows more meaningful evaluation of patients at different times and by different observers. The size of the lumen does not predict whether or not a reflux stricture is dilatable. Even a tight 2-mm. lumen can be traversed with a guidewire over which Savary dilators can be used to achieve an acceptable lumen size. Every newly diagnosed esophageal stricture warrants esophagoscopy with brushings and biopsies of the stricture (to exclude carcinoma) and an assessment of its “dilatability.” Antireflux medical therapy is not justified until carcinoma has been ruled out. Because the squamocolumnar epithelial junction may normally be found within 2 to 3 cm. of the anatomic esophagogastric junction, the diagnosis of Barrett's mucosa requires identification of the columnar epithelium at least 3 mm. proximal to the junction of the tubular esophagus and the stomach. In advanced achalasia with megaesophagus, the dilated esophagus may have a capacity of 1 to 2 liters, and simply fasting overnight does not ensure that the esophagus is empty of food and drink consumed the day before. Life-threatening massive regurgitation and aspiration may occur as the endoscope is being introduced unless an effort is made to evacuate the esophagus first by means of a nasogastric tube.