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.
J Clin Gastroenterol. 2019 Jan;53(1):9-14. doi: 10.1097/MCG.0000000000000870.
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.
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.
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.
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).
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.
洛杉矶（LA）反流性食管炎（A 至 D 级）被认为反映了胃食管反流病（GERD）的严重程度。因此，LA-D 食管炎患者可能具有导致 GERD 的大多数条件（例如肥胖、食管裂孔疝），并且 GERD 症状的发生频率最高。
本研究的主要目的是比较最严重（LA-D）和最轻微（LA-A）食管炎患者的临床特征。
在这项比较研究中，我们搜索了我们的内镜数据库，以确定诊断为 LA-D 或 LA-A 食管炎的患者，查看了他们的内镜图像，并回顾了我们确认患有 LA-D 或 LA-A 食管炎的前 100 名患者的病历。
与 LA-A 患者相比，LA-D 患者年龄更大（平均年龄 65±13.4 岁 vs. 56±13.4 岁；P<0.001），体重指数更低（25.9±5.6 岁 vs. 29.4±5.3；P<0.001），更频繁住院（70% vs. 3%；P<0.001），更频繁入住重症监护病房（15% vs. 0%；P<0.001），并且心肺疾病和胃肠道出血更为严重。相反，LA-A 患者比 LA-D 患者更常见 GERD 病史（67% vs. 45%；P=0.002）。LA-A 患者比 LA-D 患者更常发生食管裂孔疝，但差异无统计学意义（48% vs. 36%；P=0.09）。
LA-D 食管炎主要影响住院、年龄较大、非肥胖患者，这些患者通常患有严重的合并症，并且没有 GERD 或食管裂孔疝病史。相比之下，LA-A 患者通常是年龄较小、肥胖的门诊患者，他们通常有 GERD 和食管裂孔疝病史，但没有严重的合并症。LA-A 和 LA-D 患者之间的这些明显差异表明，除了典型的 GERD 以外，其他因素也可能导致 LA-D 食管炎的发病机制。
