Select the highest endoscopic grade identified to visualize GORD severity classification.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Standardized reporting of Erosive Esophagitis (EE) during gastroscopy
To guide the duration and intensity of Proton Pump Inhibitor (PPI) therapy
To predict the likelihood of GERD-related complications (Stricture, Barrett's)
Defining a 'Mucosal Break'
The LA classification is based on the presence and extent of "mucosal breaks" — areas of slough or erythema located on the mucosal folds of the distal esophagus.
Section 2
Formula & Logic
The 4 LA Grades
01
Grade A: One or more mucosal breaks ≤ 5 mm long, none of which extend between the tops of two mucosal folds.
02
Grade B: One or more mucosal breaks > 5 mm long, none of which extend between the tops of two mucosal folds.
03
Grade C: One or more mucosal breaks that are continuous between the tops of two or more mucosal folds, involving < 75% of the circumference.
04
Grade D: Mucosal breaks involving ≥ 75% of the esophageal circumference.
Complication Association
Grade A/B
Low risk of stricture; rarely associated with Barrett's
Grade C/D
High risk of stricture and underlying Barrett's Oesophagus
Section 3
Pearls/Pitfalls
LA Grade vs. PPI Dose
While Grade A/B esophagitis typically responds to standard once-daily PPI dosing, Grade C/D esophagitis often requires "High-Dose" PPI (twice daily) for initial healing and a repeat endoscopy in 8 weeks to confirm resolution and screen for obscured Barrett's esophagus.
The "Barrett's" Trap
Deep inflammation (Grade C/D) can mimic Barrett's mucosa or, conversely, can hide high-grade dysplasia. Never diagnose Barrett's or exclude it in the presence of severe acute inflammation; siempre re-endoscopy after healing.
Clinical Pearls
Grade A esophagitis is common in asymptomatic "healthy" individuals (low specificity for pathological GERD)
Inter-observer agreement is excellent (> 85%), making this superior to the older Savary-Miller classification
The junction of mucosal breaks with the Z-line should be clearly documented to rule out cardiac/gastric origin
The classification was born at the 10th World Congress in Los Angeles (1994). It was created to replace the highly subjective Savary-Miller system, which was criticized for including "complications" (like strictures) within the inflammatory grading scoring.
