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Endoscopic classification of reflux esophagitis.

Yoshio Hoshihara, Katsuhiko Iwakiri

    Nihon Rinsho. Japanese Journal of Clinical Medicine
    |December 19, 2018
    PubMed
    Summary

    Accurate classification of reflux esophagitis is crucial for treatment. A modified Los Angeles (LA) classification, including grades M and N for minimal changes and no findings, is now widely used in Japan.

    Area of Science:

    • Gastroenterology
    • Endoscopy
    • Medical Diagnostics

    Background:

    • Accurate grading of reflux esophagitis is essential for predicting treatment response.
    • The traditional Savary-Miller classification has limitations in tracking esophagitis evolution.
    • The Los Angeles (LA) classification, focusing on mucosal breaks, was introduced but found insufficient in some populations.

    Purpose of the Study:

    • To address the limitations of existing endoscopic classifications for reflux esophagitis.
    • To propose a modified LA classification suitable for the Japanese population.
    • To improve the assessment of minimal changes and treatment response in reflux esophagitis.

    Main Methods:

    • Review of existing endoscopic classifications for reflux esophagitis (Savary-Miller and LA).

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  • Analysis of the limitations of the LA classification in a Japanese study.
  • Development and proposal of a modified LA classification incorporating new grades (M and N).

    • Main Results:

    • The original LA classification (grades A-D) was found insufficient in Japan, with only 20% of heartburn patients having these grades.
    • A modified LA classification was proposed, adding grade M (minimal change esophagitis) and grade N (no esophagitis findings).
    • This modified LA classification is now widely adopted in Japan.

    Conclusions:

    • The modified LA classification enhances the assessment of reflux esophagitis severity, particularly for minimal changes and post-treatment states.
    • The proposed classification improves the ability to monitor esophagitis evolution and treatment efficacy.
    • The modified LA classification offers a more comprehensive tool for gastroenterologists in Japan.