Gut 1999;45:172-180 ( August )

Article

Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification L R Lundell^a, J Dent^b, J R Bennett^c, A L Blum^d, D Armstrong^e, J P Galmiche^f, F Johnson^g, M Hongo^h, J E Richterⁱ, S J Spechler^j, G N J Tytgat^k, L Wallin^l

^a Department of Surgery, Sahlgrenska University Hospital, Sweden, ^b Gastrointestinal Medicine, Royal Adelaide Hospital, Adelaide, South Australia, ^c Remenham House, Hull, UK, ^d Division de Gastro-entérologie, Centre Hospitalier, Universitaire Vaudois, Lausanne, Switzerland, ^e Division of Gastroenterology, McMaster University Medical Centre, Hamilton, Canada, ^f Department of Gastroenterology, Hotel-DieuCHU Nantes, France, ^g Department of Surgery, Lund's University Hospital, Sweden, ^h Tohoku University, School of Medicine, Sendai, Japan, ⁱ Department of Gastroenterology, Division of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA, ^j Department of Medicine, Beth Israel Hospital, Boston, USA, ^k Academisch Medisch Centrum, AFDLG Maas, Darm-Enleverzeiken, Amsterdam, The Netherlands, ^l Department of Surgical Gastroenterology D2, KAS Glostrup, Glostrup, Denmark

Correspondence to: Dr L Lundell, Department of Surgery, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden.

Accepted for publication 2 February 1999

BACKGROUNDEndoscopic oesophageal changes are diagnostically helpful and identify patients exposed to the risk of disease chronicity. However, there is a serious lack of agreement about how to describe and classify the appearance of reflux oesophagitis
AIMSTo examine the reliability of criteria that describe the circumferential extent of mucosal breaks and to evaluate the functional and clinical correlates of patients with reflux disease whose oesophagitis was graded according to the Los Angeles system.
METHODSForty six endoscopists from different countries used a detailed worksheet to evaluate endoscopic video recordings from 22 patients with the full range of severity of reflux oesophagitis. In separate studies, Los Angeles system gradings were correlated with 24 hour oesophageal pH monitoring (178 patients), and with clinical trials of omeprazole treatment (277 patients).
RESULTSEvaluation of circumferential extent of oesophagitis by the criterion of whether mucosal breaks extended between the tops of mucosal folds, gave acceptable agreement (mean  value 0.4) among observers. This approach is used in the Los Angeles system. An alternative approach of grouping the circumferential extent of mucosal breaks as occupying 0-25%, 26-50%, 51-75%, 76-99%, or 100% of the oesophageal circumference, gave unacceptably high interobserver variation (mean  values 0-0.15) for all but the lowest category of extent (mean  value 0.4). Severity of oesophageal acid exposure was significantly (p<0.001) related to the severity grade of oesophagitis. Preteatment oesophagitis grades A-C were related to heartburn severity (p<0.01), outcomes of omeprazole (10 mg daily) treatment (p<0.01), and the risk for symptom relapse off therapy over six months (p<0.05).
CONCLUSIONSResults add further support to previous studies for the clinical utility of the Los Angeles system for endoscopic grading of oesophagitis.


Keywords: oesophagitis; endoscopy; stricture; columnar lined mucosa; heartburn; omeprazole; acid reflux

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© 1999 by Gut
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