Endoscopic findings can be used to grade the severity of reflux esophagitis (1): Grade A: One or more mucosal breaks ≤ 5 mm that do not cross the tops of 2 mucosal folds Grade B: One or more mucosal breaks > 5 mm that do not cross the tops of 2 mucosal folds Grade C: One or more mucosal breaks that cross ≥ 2 mucosal folds and involve < 75% of the esophageal circumference Grade D: One or more mucosal breaks involving ≥ 75% of esophageal circumference Per the Lyon Consensus, grades C and D esophagitis are objective evidence of GERD (2).