Gastro-oesophageal reflux disease

Los Angeles classification of oesophagitis[61]Armstrong D, Marshall JK, Chiba N, et al; Canadian Association of Gastroenterology GERD Consensus Group. Canadian Consensus Conference on the management of gastroesophageal reflux disease in adults - update 2004. Can J Gastroenterol. 2005 Jan;19(1):15-35. http://www.ncbi.nlm.nih.gov/pubmed/15685294?tool=bestpractice.com [62]Armstrong D, Bennett JR, Blum AL, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996Jul;111(1):85-92. http://www.ncbi.nlm.nih.gov/pubmed/8698230?tool=bestpractice.com

The Los Angeles classification of oesophagitis assigns patients to grades A to D, depending on endoscopic findings of mucosal breaks in the distal oesophagus indicative of oesophagitis:

• Grade A: breaks of ≤5 mm

• Grade B: breaks >5 mm

• Grade C: breaks extending between the tops of ≥2 mucosal folds, but <75% of circumference

• Grade D: circumferential breaks (≥75%).

Hill classification of the gastro-oesophageal flap valve[61]Armstrong D, Marshall JK, Chiba N, et al; Canadian Association of Gastroenterology GERD Consensus Group. Canadian Consensus Conference on the management of gastroesophageal reflux disease in adults - update 2004. Can J Gastroenterol. 2005 Jan;19(1):15-35. http://www.ncbi.nlm.nih.gov/pubmed/15685294?tool=bestpractice.com ​

Used to assess the integrity of the gastro-oesophageal flap valve during endoscopy. A higher grade is associated with an increased risk of GORD, hiatal hernia, and lower pressure in the lower oesophageal sphincter.

• Grade I: prominent fold of tissue that encloses the endoscope

• Grade II: fold is present but with intermittent opening and rapid closing around the endoscope

• Grade III: fold barely present with failure to close around the endoscope

• Grade IV: fold absent with open space around endoscope and presence of hiatus hernia.