Unique Clinical Features of Los Angeles Grade D Esophagitis Suggest That Factors Other Than Gastroesophageal Reflux Contribute to its Pathogenesis

Anh D. Nguyen, Stuart J. Spechler, Monique N. Shuler, Rhonda F. Souza, Kerry B. Dunbar

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND:: The Los Angeles (LA) grade of reflux esophagitis (A to D) is assumed to reflect severity of the underlying gastroesophageal reflux disease (GERD). Thus, LA-D esophagitis patients might be expected to have the most conditions predisposing to GERD (eg, obesity, hiatal hernia), and the highest frequency of GERD symptoms. GOALS:: The main goal of this study is to compare clinical features of patients with the most severe (LA-D) and mildest (LA-A) grades of esophagitis. STUDY:: For this comparative study, we searched our endoscopy database for patients diagnosed with LA-D or LA-A esophagitis, reviewed their endoscopic images, and reviewed medical records of the first 100 we confirmed to have LA-D or LA-A esophagitis. RESULTS:: Compared with LA-A patients, LA-D patients were older (mean age, 65±13.4 vs. 56±13.4 y; P<0.001), had lower body mass index (25.9±5.6 vs. 29.4±5.3; P<0.001), were more frequently hospitalized (70% vs. 3%; P<0.001), and in the intensive care unit (15% vs. 0%; P<0.001), and had significantly more serious cardiopulmonary disorders and gastrointestinal bleeding. Conversely, a GERD history was more common in LA-A than LA-D patients (67% vs. 45%; P=0.002). Hiatal hernia was more frequent in LA-A patients than LA-D patients, but not significantly (48% vs. 36%; P=0.09). CONCLUSIONS:: LA-D esophagitis primarily affects hospitalized, older, nonobese patients who often have serious comorbidities, and no history of GERD or hiatal hernia. In contrast, LA-A patients are generally younger, obese outpatients who often have a history of GERD and hiatal hernia without serious comorbidities. These profound differences between LA-A and LA-D patients suggest that factors other than typical GERD contribute to LA-D esophagitis pathogenesis.

Original languageEnglish (US)
JournalJournal of Clinical Gastroenterology
DOIs
StateAccepted/In press - Jun 21 2017

Fingerprint

Los Angeles
Esophagitis
Gastroesophageal Reflux
Hiatal Hernia
Comorbidity
Peptic Esophagitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{7ef41a7ce441415783a5c4b0ba3a141d,
title = "Unique Clinical Features of Los Angeles Grade D Esophagitis Suggest That Factors Other Than Gastroesophageal Reflux Contribute to its Pathogenesis",
abstract = "BACKGROUND:: The Los Angeles (LA) grade of reflux esophagitis (A to D) is assumed to reflect severity of the underlying gastroesophageal reflux disease (GERD). Thus, LA-D esophagitis patients might be expected to have the most conditions predisposing to GERD (eg, obesity, hiatal hernia), and the highest frequency of GERD symptoms. GOALS:: The main goal of this study is to compare clinical features of patients with the most severe (LA-D) and mildest (LA-A) grades of esophagitis. STUDY:: For this comparative study, we searched our endoscopy database for patients diagnosed with LA-D or LA-A esophagitis, reviewed their endoscopic images, and reviewed medical records of the first 100 we confirmed to have LA-D or LA-A esophagitis. RESULTS:: Compared with LA-A patients, LA-D patients were older (mean age, 65±13.4 vs. 56±13.4 y; P<0.001), had lower body mass index (25.9±5.6 vs. 29.4±5.3; P<0.001), were more frequently hospitalized (70{\%} vs. 3{\%}; P<0.001), and in the intensive care unit (15{\%} vs. 0{\%}; P<0.001), and had significantly more serious cardiopulmonary disorders and gastrointestinal bleeding. Conversely, a GERD history was more common in LA-A than LA-D patients (67{\%} vs. 45{\%}; P=0.002). Hiatal hernia was more frequent in LA-A patients than LA-D patients, but not significantly (48{\%} vs. 36{\%}; P=0.09). CONCLUSIONS:: LA-D esophagitis primarily affects hospitalized, older, nonobese patients who often have serious comorbidities, and no history of GERD or hiatal hernia. In contrast, LA-A patients are generally younger, obese outpatients who often have a history of GERD and hiatal hernia without serious comorbidities. These profound differences between LA-A and LA-D patients suggest that factors other than typical GERD contribute to LA-D esophagitis pathogenesis.",
author = "Nguyen, {Anh D.} and Spechler, {Stuart J.} and Shuler, {Monique N.} and Souza, {Rhonda F.} and Dunbar, {Kerry B.}",
year = "2017",
month = "6",
day = "21",
doi = "10.1097/MCG.0000000000000870",
language = "English (US)",
journal = "Journal of Clinical Gastroenterology",
issn = "0192-0790",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Unique Clinical Features of Los Angeles Grade D Esophagitis Suggest That Factors Other Than Gastroesophageal Reflux Contribute to its Pathogenesis

AU - Nguyen, Anh D.

AU - Spechler, Stuart J.

AU - Shuler, Monique N.

AU - Souza, Rhonda F.

AU - Dunbar, Kerry B.

PY - 2017/6/21

Y1 - 2017/6/21

N2 - BACKGROUND:: The Los Angeles (LA) grade of reflux esophagitis (A to D) is assumed to reflect severity of the underlying gastroesophageal reflux disease (GERD). Thus, LA-D esophagitis patients might be expected to have the most conditions predisposing to GERD (eg, obesity, hiatal hernia), and the highest frequency of GERD symptoms. GOALS:: The main goal of this study is to compare clinical features of patients with the most severe (LA-D) and mildest (LA-A) grades of esophagitis. STUDY:: For this comparative study, we searched our endoscopy database for patients diagnosed with LA-D or LA-A esophagitis, reviewed their endoscopic images, and reviewed medical records of the first 100 we confirmed to have LA-D or LA-A esophagitis. RESULTS:: Compared with LA-A patients, LA-D patients were older (mean age, 65±13.4 vs. 56±13.4 y; P<0.001), had lower body mass index (25.9±5.6 vs. 29.4±5.3; P<0.001), were more frequently hospitalized (70% vs. 3%; P<0.001), and in the intensive care unit (15% vs. 0%; P<0.001), and had significantly more serious cardiopulmonary disorders and gastrointestinal bleeding. Conversely, a GERD history was more common in LA-A than LA-D patients (67% vs. 45%; P=0.002). Hiatal hernia was more frequent in LA-A patients than LA-D patients, but not significantly (48% vs. 36%; P=0.09). CONCLUSIONS:: LA-D esophagitis primarily affects hospitalized, older, nonobese patients who often have serious comorbidities, and no history of GERD or hiatal hernia. In contrast, LA-A patients are generally younger, obese outpatients who often have a history of GERD and hiatal hernia without serious comorbidities. These profound differences between LA-A and LA-D patients suggest that factors other than typical GERD contribute to LA-D esophagitis pathogenesis.

AB - BACKGROUND:: The Los Angeles (LA) grade of reflux esophagitis (A to D) is assumed to reflect severity of the underlying gastroesophageal reflux disease (GERD). Thus, LA-D esophagitis patients might be expected to have the most conditions predisposing to GERD (eg, obesity, hiatal hernia), and the highest frequency of GERD symptoms. GOALS:: The main goal of this study is to compare clinical features of patients with the most severe (LA-D) and mildest (LA-A) grades of esophagitis. STUDY:: For this comparative study, we searched our endoscopy database for patients diagnosed with LA-D or LA-A esophagitis, reviewed their endoscopic images, and reviewed medical records of the first 100 we confirmed to have LA-D or LA-A esophagitis. RESULTS:: Compared with LA-A patients, LA-D patients were older (mean age, 65±13.4 vs. 56±13.4 y; P<0.001), had lower body mass index (25.9±5.6 vs. 29.4±5.3; P<0.001), were more frequently hospitalized (70% vs. 3%; P<0.001), and in the intensive care unit (15% vs. 0%; P<0.001), and had significantly more serious cardiopulmonary disorders and gastrointestinal bleeding. Conversely, a GERD history was more common in LA-A than LA-D patients (67% vs. 45%; P=0.002). Hiatal hernia was more frequent in LA-A patients than LA-D patients, but not significantly (48% vs. 36%; P=0.09). CONCLUSIONS:: LA-D esophagitis primarily affects hospitalized, older, nonobese patients who often have serious comorbidities, and no history of GERD or hiatal hernia. In contrast, LA-A patients are generally younger, obese outpatients who often have a history of GERD and hiatal hernia without serious comorbidities. These profound differences between LA-A and LA-D patients suggest that factors other than typical GERD contribute to LA-D esophagitis pathogenesis.

UR - http://www.scopus.com/inward/record.url?scp=85021146633&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021146633&partnerID=8YFLogxK

U2 - 10.1097/MCG.0000000000000870

DO - 10.1097/MCG.0000000000000870

M3 - Article

C2 - 28644313

AN - SCOPUS:85021146633

JO - Journal of Clinical Gastroenterology

JF - Journal of Clinical Gastroenterology

SN - 0192-0790

ER -