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Unique Clinical Features of Los Angeles Grade D Esophagitis Suggest That Factors Other Than Gastroesophageal Reflux Contribute to its Pathogenesis

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Background:

The Los Angeles (LA) grade of reflux esophagitis (A to D) is assumed to reflect severity of the underlying gastroesophageal reflux disease (GERD). Thus, LA-D esophagitis patients might be expected to have the most conditions predisposing to GERD (eg, obesity, hiatal hernia), and the highest frequency of GERD symptoms.

Goals:

The main goal of this study is to compare clinical features of patients with the most severe (LA-D) and mildest (LA-A) grades of esophagitis.

Study:

For this comparative study, we searched our endoscopy database for patients diagnosed with LA-D or LA-A esophagitis, reviewed their endoscopic images, and reviewed medical records of the first 100 we confirmed to have LA-D or LA-A esophagitis.

Results:

Compared with LA-A patients, LA-D patients were older (mean age, 65±13.4 vs. 56±13.4 y; P<0.001), had lower body mass index (25.9±5.6 vs. 29.4±5.3; P<0.001), were more frequently hospitalized (70% vs. 3%; P<0.001), and in the intensive care unit (15% vs. 0%; P<0.001), and had significantly more serious cardiopulmonary disorders and gastrointestinal bleeding. Conversely, a GERD history was more common in LA-A than LA-D patients (67% vs. 45%; P=0.002). Hiatal hernia was more frequent in LA-A patients than LA-D patients, but not significantly (48% vs. 36%; P=0.09).

Conclusions:

LA-D esophagitis primarily affects hospitalized, older, nonobese patients who often have serious comorbidities, and no history of GERD or hiatal hernia. In contrast, LA-A patients are generally younger, obese outpatients who often have a history of GERD and hiatal hernia without serious comorbidities. These profound differences between LA-A and LA-D patients suggest that factors other than typical GERD contribute to LA-D esophagitis pathogenesis.
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Keywords: endoscopy; gastroesophageal reflux disease; hiatal hernia; reflux esophagitis

Document Type: Research Article

Affiliations: 1: Department of Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center 2: Department of Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott and White Research Institute, Department of Medicine, Dallas VA Medical Center, Division of Gastroenterology and Hepatology, Dallas, TX 3: Clinical Informatics, Southeast Louisiana Veterans Healthcare System, New Orleans, LA 4: Department of Medicine, Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Department of Medicine, Dallas VA Medical Center, Division of Gastroenterology and Hepatology, Dallas, TX

Publication date: January 1, 2019

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