Endoscopic assessment of oesophagitis

Clinical and functional correlates and further validation of the Los Angeles classification

L. R. Lundell, J. Dent, J. R. Bennett, A. L. Blum, D. Armstrong, J. P. Galmiche, F. Johnson, M. Hongo, J. E. Richter, S. J. Spechler, G. N J Tytgat, L. Wallin

Research output: Contribution to journalArticle

1354 Citations (Scopus)

Abstract

Background - Endoscopic 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 Aims-To 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. Methods - Forty 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). Results - Evaluation of circumferential extent of oesophagitis by the criterion of whether mucosal breaks extended between the tops of mucosal folds, gave acceptable agreement (mean κ 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 κ values 0-0.15) for all but the lowest category of extent (mean κ value 0.4). Severity of oesophageal acid exposure was significantly (p<0.001) related to the severity grade of oesophagitis. Pretreatment 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). Conclusions - Results add further support to previous studies for the clinical utility of the Los Angeles system for endoscopic grading of oesophagitis.

Original languageEnglish (US)
Pages (from-to)172-180
Number of pages9
JournalGut
Volume45
Issue number2
StatePublished - 1999

Fingerprint

Los Angeles
Esophagitis
Peptic Esophagitis
Omeprazole
Esophageal pH Monitoring
Heartburn
Video Recording
Observer Variation
Therapeutics
Clinical Trials
Recurrence
Acids

Keywords

  • Acid reflux
  • Columnar lined mucosa
  • Endoscopy
  • Heartburn
  • Oesophagitis
  • Omeprazole
  • Stricture

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Lundell, L. R., Dent, J., Bennett, J. R., Blum, A. L., Armstrong, D., Galmiche, J. P., ... Wallin, L. (1999). Endoscopic assessment of oesophagitis: Clinical and functional correlates and further validation of the Los Angeles classification. Gut, 45(2), 172-180.

Endoscopic assessment of oesophagitis : Clinical and functional correlates and further validation of the Los Angeles classification. / Lundell, L. R.; Dent, J.; Bennett, J. R.; Blum, A. L.; Armstrong, D.; Galmiche, J. P.; Johnson, F.; Hongo, M.; Richter, J. E.; Spechler, S. J.; Tytgat, G. N J; Wallin, L.

In: Gut, Vol. 45, No. 2, 1999, p. 172-180.

Research output: Contribution to journalArticle

Lundell, LR, Dent, J, Bennett, JR, Blum, AL, Armstrong, D, Galmiche, JP, Johnson, F, Hongo, M, Richter, JE, Spechler, SJ, Tytgat, GNJ & Wallin, L 1999, 'Endoscopic assessment of oesophagitis: Clinical and functional correlates and further validation of the Los Angeles classification', Gut, vol. 45, no. 2, pp. 172-180.
Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP et al. Endoscopic assessment of oesophagitis: Clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45(2):172-180.
Lundell, L. R. ; Dent, J. ; Bennett, J. R. ; Blum, A. L. ; Armstrong, D. ; Galmiche, J. P. ; Johnson, F. ; Hongo, M. ; Richter, J. E. ; Spechler, S. J. ; Tytgat, G. N J ; Wallin, L. / Endoscopic assessment of oesophagitis : Clinical and functional correlates and further validation of the Los Angeles classification. In: Gut. 1999 ; Vol. 45, No. 2. pp. 172-180.
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AU - Blum, A. L.

AU - Armstrong, D.

AU - Galmiche, J. P.

AU - Johnson, F.

AU - Hongo, M.

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