Can the Los Angeles classification be used for esophagitis secondary to Gastroesophageal Reflux Disease (GERD)?

Los Angeles Classification for GERD-Related Esophagitis

Yes, the Los Angeles (LA) classification system is specifically designed for and should be used to grade erosive esophagitis secondary to GERD. 1

GERD-Specific Application

The LA classification is the standard grading system for GERD-related erosive esophagitis and should be applied during endoscopic evaluation of suspected GERD patients. 1 Complete endoscopic evaluation of GERD symptoms includes inspection for erosive esophagitis graded according to the Los Angeles classification when present. 1

Clinical Significance by Grade

• LA Grade B or higher constitutes confirmatory evidence of erosive reflux disease and represents conclusive objective evidence of GERD 1
• LA Grade C or D represents severe erosive disease requiring either continuous long-term PPI therapy or consideration of anti-reflux intervention 1
• LA Grade A can be seen in healthy asymptomatic volunteers and is NOT considered evidence of erosive reflux disease 1

Recent research confirms that 100% of patients with LA grade B esophagitis have objective GERD on pH monitoring, comparable to LA grade C (which is 100% conclusive by definition), while only 17.6% with LA grade A have objective GERD. 2

Critical Limitation: Not for Non-GERD Esophagitis

The LA classification should NOT be used for esophagitis from other etiologies. 3 Before applying the LA classification, you must exclude:

• Eosinophilic esophagitis 3
• Infectious esophagitis 3
• Medication-induced esophagitis 3
• Crohn's disease-related esophagitis 3

Alternative Classification Systems

For eosinophilic esophagitis, use the Eosinophilic Esophagitis Endoscopic Reference System (EREFS) or the Index for Severity of Eosinophilic Esophagitis (I-SEE) score instead. 3 Diagnosis requires ≥15 eosinophils per high-power field on biopsy from both proximal and distal esophagus. 3

Practical Application Algorithm

Apply LA classification only when:

1. Erosive changes are present endoscopically 3
2. The distal esophagus is primarily involved 3
3. Biopsies confirm acid-related injury without significant eosinophilia 3

The LA classification has been extensively validated, demonstrating acceptable interobserver agreement (kappa 0.4), correlation with 24-hour pH monitoring severity, and prediction of treatment outcomes and relapse risk. 4, 5 It remains the most reproducible and practical grading system for GERD-related erosive esophagitis. 5