Esophagus to Small Intestine
Am J Gastroenterol. 2023;118(5):794−801
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.