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Los Angeles Classification: Short explanation and description

Los Angeles Classification: Short explanation and description. John Dent Chair, International Working Group for the Classification of Oesophagitis. How the Los Angeles Classification defines and grades the severity of reflux esophagitis.

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Los Angeles Classification: Short explanation and description

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  1. Los Angeles Classification: Short explanation and description John Dent Chair, International Working Group for the Classification of Oesophagitis

  2. How the Los Angeles Classification defines and grades the severity of reflux esophagitis • Uses reliable endoscopic criteria for diagnosis of esophagitis • Provides explicit criteria for grading of the severity of esophagitis

  3. Reliable endoscopic criteria for diagnosis of esophagitis • Endoscopically visible mucosal breaks (either erosion or ulceration) are the criterion for the endoscopic diagnosis of esophagitis • So-called minimal changes are not used as criteria in the LA Classification since formal validation studies show that these cannot be recognized reliably by endoscopists Bytzer et al., Scand J Gastroenterol 28;119-125 (1993)

  4. Definition of endoscopic appearance of a mucosal break “An area of slough or erythema with a sharp line of demarcation from adjacent normal mucosa”

  5. Criteria used to grade the severity of esophagitis • Only the extent of mucosal breaks determines Los Angeles grade • Complications of esophagitis such as stricture and Barrett’s Esophagus do not accurately reflect severity of esophagitis, especially during treatment • complications therefore do not influence Los Angeles grade, but their presence should be reported separately

  6. Esophageal mucosal folds are used to determine radial extent Mucosal folds best demonstrated by partial deflation of the esophagus 1 cm Lundell et al., Gut 45:172-180 (1999)

  7. Los Angeles grade A esophagitis – One (or more) mucosal breakno longer than 5 mmthat does not extend between the tops of two mucosal folds 1 cm Lundell et al., Gut 45:172-180 (1999)

  8. Los Angeles grade B esophagitis – One (or more) mucosal breakmore than 5 mmthat does not extend between the tops of two mucosal folds 1 cm Lundell et al., Gut 45:172-180 (1999)

  9. Los Angeles grade C esophagitis – One (or more) mucosal break thatis continuous between the tops of two mucosal foldsbut which involvesless than 75%of the circumference 1 cm Lundell et al., Gut 45:172-180 (1999)

  10. Los Angeles grade D esophagitis – One (or more) mucosal break which involvesat least 75%of the esophageal circumference 1 cm Lundell et al., Gut 45:172-180 (1999)

  11. Los Angeles Classification of reflux esophagitis LA grade A LA grade B One (or more) mucosal break no longer than 5 mm, that does not extend between the tops of two mucosal folds One (or more) mucosalbreak more than 5 mm long, that does not extend between the tops of two mucosal folds 1 cm 1 cm LA grade C LA grade D One (or more) mucosal break that is continuous between the tops of two or more mucosal folds, but which involves less than 75% of the circumference One (or more) mucosalbreak which involves atleast 75% of the esophageal circumference 1 cm 1 cm Lundell et al., Gut 45:172-180 (1999)

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