Endoscopic Presence of LA Grade B but Not Grade A Erosive Esophagitis Confirms GERD

Endoscopic Presence of LA Grade B but Not Grade A Erosive Esophagitis Confirms GERD

Prateek Sharma, MD, FASGE, reviewing Visaggi P, et al. Am J Gastroenterol 2022 Dec 29.

Per the Lyon Consensus, endoscopic documentation of Los Angeles (LA) grade C or D esophagitis is conclusive evidence of GERD, whereas LA grades A and B esophagitis are inconclusive for a GERD diagnosis, and further testing is required. The primary aim of the current study was to evaluate symptomatic patients with LA grade A, B, or C esophagitis and compare findings from multichannel intraluminal impedance and pH (MII-pH) monitoring to determine whether patients with a specific LA grade esophagitis provide objective GERD evidence. 

In this multicenter retrospective study, 155 patients (81 females; median age, 52 years; median body mass index, 26) met the inclusion criteria. Patient age, lifestyle/dietary habits, and clinical presentation were similar across the patients separated into 3 groups according to their LA grade of esophagitis (LA grade A=74; LA grade B=61; LA grade C=20). 

Using MII-pH monitoring, 17.6% of patients with grade A esophagitis, 100% with grade B, and 75% with grade C had objective evidence of GERD. Using pH metry, the acid exposure time of >6% was seen in 1.4%, 52.5%, and 75% of patients with LA grades A, B, and C esophagitis, respectively. With the use of MII-pH data, an additional 16.2% of patients with LA grade A and 47.5% with LA grade B esophagitis had an acid exposure time of 4% to 6%. Finally, compared with patients with LA grade C esophagitis, 100% of those with LA grade B esophagitis had objective GERD versus only 17.6% with LA grade A esophagitis (P<.001).

Prateek Sharma, MD, FASGE


Patients with LA grade B erosive esophagitis demonstrate evidence of objective GERD when the acid exposure time is >6% in reflux monitoring. The finding of LA grade B esophagitis on endoscopy confirms GERD and may not need further testing.



Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Visaggi P, Del Corso G, Gyawali CP, et al. Ambulatory pH-impedance findings confirm that grade B esophagitis provides objective diagnosis of gastroesophageal reflux disease. Am J Gastroenterol 2022 Dec 29. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000002173)

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