Esophagus to Small Intestine

Am J Gastroenterol. 2023;118(5):794−801

Visaggi P, Del Corso G, Gyawali CP, Ghisa M, Baiano Svizzero F, Stefani Donati D, Venturini A, Savarino V, Penagini R, Zeki S, Bellini M, Savarino EV, de Bortoli N

Ambulatory pH-impedance findings confirm that grade B esophagitis provides objective diagnosis of gastroesoph-ageal reflux disease

Introduction: The Lyon Consensus designates Los Angeles (LA) grade C/D esophagitis or acid exposure time (AET) > 6% on impedance-pH moni-toring (MII-pH) as conclusive for gastroesophageal reflux disease (GERD). The authors aimed to evaluate proportions with objective GERD among symptomatic patients with LA grade A, B, and C esophagitis on endoscopy.
Methods: Demographics, clinical data, endoscopy findings, and objective proton-pump inhibitor response were collected from symptomatic prospectively enrolled patients from 2 referral centers. Off-therapy MII-pH parameters included AET, number of reflux episodes, mean nocturnal baseline impedance, and postreflux swallow-induced peristaltic wave index. Objective GERD evidence was compared between LA grades.
Results: Of 155 patients (LA grade A: 74 patients, B: 61 patients, and C: 20 patients), demographics and presentation were similar across LA grades. AET > 6% was seen in 1.4%, 52.5%, and 75%, respectively, in LA grades A, B, and C. Using additional MII-pH metrics, an additional 16.2% with LA grade A and 47.5% with LA grade B esophagitis had AET 4−6% with low mean nocturnal baseline impedance and postreflux swal-low-induced peristaltic wave index; there were no additional gains using the number of reflux episodes or symptom-reflux association metrics. Compared with LA grade C (100% conclusive GERD based on endoscopic findings), 100% of LA grade B esophagitis also had objective GERD but only 17.6% with LA grade A esophagitis (p < 0.001 compared with each). Proton-pump inhibitor response was comparable between LA grades B and C (74% and 70%, respectively) but low in LA grade A (39%, p < 0.001).

Discussion: Grade B esophagitis indicates an objective diagnosis of gastroesophageal reflux disease.

Prof. Dr. N. de Bortoli, Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy,

DOI: 10.14309/ajg.0000000000002173

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