Los Angeles (LA) Grading of Esophagitis

When to use

• Standardising the endoscopic description and severity of reflux esophagitis for communication between endoscopists and for treatment/follow-up planning.

Formula

Classification (not a summed score) by extent and confluence of mucosal breaks seen at endoscopy: Grade A (<=5mm, non-confluent) to Grade D (confluent, >=75% circumference).

Pearls and pitfalls

• Has largely replaced the older Savary-Miller classification because of better inter-observer reproducibility.
• Grades C and D correlate with a substantially higher likelihood of Barrett's esophagus and stricture.

References

1. Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45(2):172-80.