Endoscopic grading of reflux oesophagitis: the past, present and future

The Los Angeles Classification for diagnosis and grading of reflux oesophagitis, first discussed at the 1994 World Congress of Gastroenterology, was published in its definitive form in 1999. The product of a demanding validation process, it consistently predicts the outcome of acid suppressant therapy, correlates with oesophageal acid exposure, and is the most reproducible and practical of oesophagitis grading systems. The attributes of the classification, which enhance the specificity of communication on reflux oesophagitis, are widely recognized, as it is now by far the most widely used method for description of reflux oesophagitis. Exclusion of minimal oesophageal mucosal change is, however, regarded as a significant limitation by some users, especially in Japan. Some data suggest that minimal changes may now be recognized with modern endoscopes; if this claim can be adequately validated, formal addition of criteria for minimal change could significantly improve the sensitivity of endoscopy for reflux disease.