[Endoscopic classification of reflux esophagitis].

It is important to accurately classify the severity of reflux esophagitis, because the clinical response to treatment is dependent on the severity of erosive lesions. In Japan we had used Savary-Miller classification for endoscopic grading. In this classification stage I to III encompass mucosal erosions of increasing extent, while stage IV includes all complications, which make it difficult to follow the evolution of the esophagitis and its response to treatment. A new endoscopic classification was proposed at the World Congress of Gastroenterology in Los Angeles in 1994. A mucosal break was emphasized which was defined as an area of slough or erythema with a sharp demarcation between it and the adjacent mucosa. Mucosal breaks are classified into 4 grades from A to D according to their extension. The complica- tions are not included in this grading system. Japanese study revealed that only 20 % of patients with heartburn had grade Aio D. This means that LA classification is insufficient at least in Japan. We have proposed,the modified LA classification including grade M and N, adding the original classification. Grade M pre- sents minimal change esophagitis and an undemarcated erythema after treatment of the muco- sal break using H2 blocker or PPI, whilst grade N represents no findings of esophagitis. Now this modified LA classification is widely used in Japan.