First, what is a gastroscopy and how is the report organized?

A gastroscopy —its technical name is esophagogastroduodenoscopy (EGD)— is a test in which we pass a thin, flexible tube with a camera at the tip (the endoscope) through the mouth to examine the inside of the first three parts of the digestive tract:

• • The esophagus (the tube connecting the mouth to the stomach).
• • The stomach.
• • The duodenum (the first part of the small intestine).

Almost all reports follow the same route the endoscope takes: first they describe the esophagus, then the stomach and finally the duodenum. At the end there is usually a conclusion or "diagnostic impression" with the summary, and a biopsies section if samples were taken for microscopic analysis. If you want to know when this test is indicated, I explain it in my guide on when a gastroscopy is recommended.

Part 1. The normal findings: when everything is in its place

A good part of the report simply confirms that the anatomy is normal. Knowing these terms will help you tell pure description apart from a relevant finding.

In the esophagus

• • Normal-looking mucosa: the lining inside the esophagus is smooth, pale pink and shiny. That is what we expect to see.
• • Z-line or squamocolumnar junction (SCJ): the border where the pink esophageal lining ends and the more orange stomach lining begins. If it says "regular", "sharp" or "at the level of the hiatus", it is where it should be.
• • Gastroesophageal junction (GEJ): the point where the esophagus joins the stomach.
• • Diaphragmatic hiatus: the opening in the diaphragm through which the esophagus passes into the abdomen. "Competent" or "closed" is normal.
• • Preserved peristalsis: the coordinated movements that push food toward the stomach are working normally.

In the stomach

The stomach is divided into several areas you will see named in the report:

• • Fundus: the highest, dome-shaped part.
• • Gastric body: the central, widest part.
• • Antrum: the final part, before the exit toward the duodenum.
• • Incisura angularis (angular notch): the fold marking the boundary between the body and the antrum.
• • Pylorus: the muscular "valve" connecting the stomach to the duodenum. "Centered", "patent" or "of normal opening" is what we want.
• • Gastric folds: the normal folds of the lining; seen mainly in the body.
• • Mucous lake: the small pool of juice and mucus that naturally collects in the lower part of the stomach.
• • Retroflexion or J-maneuver: a routine maneuver in which we turn the endoscope back on itself to look "backward" and examine the fundus and the cardia. It is standard, not a complication.

In the duodenum

• • Duodenal bulb: the first part of the duodenum, right after the pylorus.
• • Second duodenal portion (duodenal knee): the next stretch, where we usually end the exam.
• • Folds of Kerckring or valvulae conniventes: the normal circular folds of the small intestine; they give it a "velvety" look.
• • Preserved villi: the tiny projections of the lining that absorb nutrients. When they are fine, it is a good sign (their loss is typical, for example, of celiac disease).
• • Papilla of Vater (major papilla): the small opening where bile and pancreatic juice drain. Describing it is routine.

Part 2. The abnormal findings: the dictionary term by term

Here are the findings that do indicate some change. Remember: the vast majority are benign and treatable. I have organized them by organ.

Findings in the esophagus

• • Esophagitis: inflammation of the esophageal lining. The most frequent cause is reflux, though it can also be due to infections, allergies or pills. When there are breaks in the lining it is graded with the Los Angeles classification (you will see it below).
• • Hiatal hernia: part of the stomach slides into the chest through the hiatus. It is very common and often causes no symptoms, although it favors reflux. The report usually states its size in centimeters.
• • Barrett's esophagus: the normal esophageal lining is replaced by one resembling the intestine, due to chronic reflux. It matters because it requires surveillance; its extent is measured with the Prague criteria.
• • Schatzki ring: a ring-shaped narrowing in the lower esophagus that can make swallowing difficult.
• • Esophageal stricture: a narrowing of the esophagus, which may be benign (from chronic reflux) or require investigation.
• • Eosinophilic esophagitis: an inflammation of allergic origin. In the report it may appear as trachealization or concentric rings, longitudinal furrows or whitish exudates/spots. It is always confirmed with biopsies.
• • Esophageal candidiasis: a fungal infection appearing as whitish plaques stuck to the lining.
• • Esophageal varices: dilated veins in the esophageal wall, usually associated with liver disease. They have their own grading.
• • Diverticulum (for example, Zenker's): a pouch or sac forming in the wall.

Findings in the stomach

• • Gastritis: inflammation of the stomach lining. You will see several "surnames":
  • – Erythematous: the lining is reddened.
  • – Erosive: there are small superficial erosions.
  • – Atrophic: the lining has "thinned" and lost glands over time. It matters because it sometimes requires follow-up (it is classified with the OLGA/OLGIM systems).
  • – Nodular: with a small-bump appearance, frequent in relation to Helicobacter pylori.
• • Intestinal metaplasia: the stomach lining takes on features of the intestinal lining. It usually results from chronic inflammation and is monitored together with atrophy.
• • Helicobacter pylori (H. pylori): a very common bacterium that causes gastritis and ulcers. It is sometimes suspected from the appearance and confirmed with a test (urease test or biopsy).
• • Gastric ulcer: a wound or sore in the stomach wall. If it is bleeding or shows signs of having bled, it is classified with the Forrest scale.
• • Gastric polyps: small growths of the lining. I cover them in detail in my post on gastric polyps. The most frequent are:
  • – Fundic gland polyps: almost always benign, very common, especially in those taking stomach-protecting drugs.
  • – Hyperplastic: generally benign, associated with inflammation.
  • – Adenomatous (adenomas): they require more attention because they may have transformation potential; they are usually removed.
• • GAVE or "watermelon stomach": reddish lines in the antrum resembling watermelon stripes that can cause anemia.
• • Angiodysplasia: small vessel malformations that sometimes bleed.
• • Dieulafoy lesion: an abnormally large artery beneath the lining that can be a cause of bleeding.
• • Gastric xanthoma: a small yellowish plaque, completely benign.

Findings in the duodenum

• • Duodenitis: inflammation of the duodenal lining.
• • Duodenal ulcer: a sore in the bulb or duodenum; strongly linked to H. pylori and anti-inflammatory drugs.
• • Villous atrophy or flattening of the villi: the villi flatten and the lining loses its relief. It is the typical finding of celiac disease; it may be described as a mosaic pattern, scalloping of the folds or flattened folds, and is always confirmed with biopsies.
• • Duodenal lymphangiectasia: small whitish spots from dilated lymphatic vessels, usually of no importance.

Terms that can appear in any area

• • Submucosal or subepithelial lesion: a "bump" arising beneath the lining, which looks normal on top. The vast majority are benign.
• • Friability: the lining bleeds easily when touched, which usually indicates inflammation.
• • Congestive or edematous mucosa: reddened or swollen, signs of inflammation.
• • Biopsy: taking a small tissue sample to examine under the microscope. It is very routine and does not necessarily mean something is wrong; often it serves precisely to confirm everything is fine.
• • Pending pathology / histology result: samples have been sent to the lab and the definitive diagnosis of that part will arrive in a few days.

Part 3. The severity scales: what those letters and numbers mean

This is the part that confuses people most, because classifications with letters and numbers appear. They are international systems we doctors use to describe severity objectively and so that any specialist in the world understands the same thing. Many of them are gathered in the guidelines of the European Society of Gastrointestinal Endoscopy (ESGE), which I link at the end. Here are the most common ones.

Los Angeles classification (reflux esophagitis)

It is the standard scale for grading esophagitis when there are breaks (erosions) in the lining. It goes from least to most:

In practice, grades A and B are mild and very common; grades C and D are more important and usually require more intensive treatment and a follow-up check. (In older reports you may see the Savary-Miller classification, with grades I to IV for the same thing; today the Los Angeles one is preferred.)

Prague C&M criteria (Barrett's esophagus)

They are used to measure how much Barrett's there is, with two letters followed by a number in centimeters:

• • C (circumferential): how many centimeters of Barrett's fully circle the esophagus.
• • M (maximum): the maximum length reached, including the "tongues" that go higher up.

For example, C2M5 means there are 2 cm circling the whole esophagus and the longest tongue reaches up to 5 cm. The larger the numbers, the greater the extent of Barrett's. The use of these criteria is recommended by the ESGE Barrett's esophagus guideline (2023).

Forrest classification (bleeding ulcer)

It describes the appearance of an ulcer and its risk of bleeding again. It goes from most active to most quiet:

The rule is simple: the closer to Ia, the higher the risk and the greater the need for treatment during the endoscopy; Forrest III is the lowest-risk one. It is the scale used by the ESGE nonvariceal upper GI hemorrhage guideline (2021).

OLGA and OLGIM systems (atrophic gastritis and intestinal metaplasia)

These two systems assess risk in patients with chronic gastritis:

• • OLGA is based on the degree of atrophy (loss of glands).
• • OLGIM is based on the degree of intestinal metaplasia.

Both classify into stages 0 to IV combining the intensity and the location of the changes. The key idea for you: stages 0, I and II are considered low risk, while stages III and IV are the higher-risk ones and advise periodic endoscopic surveillance. It is like a risk traffic light that lets us personalize the check-ups, as set out in the ESGE/EHMSG/ESP MAPS III guideline (2025).

Paris classification (superficial lesions and polyps)

It describes the shape of a superficial lesion, which helps decide how to treat it:

It is especially useful in advanced endoscopy, because the shape of the lesion guides the best technique to remove it completely (mucosal resection or endoscopic submucosal dissection).

Hill classification (gastroesophageal valve)

It is assessed on retroflexion (looking "backward" inside the stomach) and describes how well the stomach entrance closes around the endoscope. It relates to reflux:

Grades III and IV are associated with a greater tendency to reflux.

Esophageal varices

When there are varices, the report usually states their size (small, medium or large) and whether they have red signs on their surface, which indicate a higher bleeding risk and the need for treatment, as detailed in the ESGE esophagogastric variceal hemorrhage guideline (2022).

Part 4. A quick guide: words that reassure and words that deserve follow-up

To read the report at a glance, keep in mind this general orientation (which never replaces your doctor's assessment):

In summary

Your gastroscopy report is a valuable tool, but it is written in a technical language. I hope this guide has served as a translator to tell the normal apart from what deserves attention, and to understand what those letters and numbers of the severity scales mean.

That said, no report is interpreted in isolation. The same finding can have very different implications depending on your symptoms, your age, your history and the biopsy results. So, if you have received a report you don't understand or that worries you, the best thing is to discuss it with your digestive specialist, who will put it in context and explain which steps — if any are needed — are the most appropriate for you. You can see all the related topics in my gastrointestinal disorders section.

As a gastroenterologist with more than 15 years of experience in advanced endoscopy, my goal is always the same: that you understand what is happening to your body and that you make decisions calmly and with all the information.

Related reading

When is a gastroscopy recommended?

Symptoms and situations in which the test is indicated.

Read post →

Gastric polyps: what they mean

Types of stomach polyps and which ones need attention.

Read post →

Heartburn tips you don't know

Practical tips to control reflux in everyday life.

Read post →

Frequently asked questions about the endoscopy report