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

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).