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The Los Angeles and Savary-Miller systems for grading esophagitis: utilization and correlation with histology.
MedLine Citation:
PMID:  20659145     Owner:  NLM     Status:  In-Data-Review    
The aim of the study is to determine the proportion of patients who have esophageal biopsy specimens taken for an endoscopic diagnosis of reflux esophagitis in which an endoscopic grade of esophagitis (Los Angeles [LA] or Savary-Miller [SM]) is communicated to the pathologist, and to evaluate the correlation between those endoscopic grades and histopathologic findings. We searched the database of Caris Diagnostics (a large, gastrointestinal pathology practice that receives specimens from community-based endoscopy centers), and extracted data from all patients who had an endoscopy with esophageal biopsies submitted in a 12-month period. There were esophageal biopsy specimens from 49 480 patients obtained during 58 986 endoscopies. The LA grade was provided in 5513 cases (27.9% of 19 778 with endoscopic esophagitis); the SM grade was stated in only 2416 cases (12.2%). A histopathologic diagnosis of erosive or ulcerative esophagitis was made significantly less often in LA grade A patients (3.2%) than in those with LA grades C (20.0%) and D (23.3%); erosive or ulcerative esophagitis was found in only 1.4% of patients with SM grade I and in 35.5% of cases with grade IV. Endoscopists who biopsy the esophagus of patients with reflux esophagitis usually do not communicate the grade of esophagitis to the pathologist. Although both the LA and SM grading systems are based on the presence of esophageal mucosal breaks (erosions or ulcers), in practice such breaks are documented in only a minority of esophageal biopsy specimens taken from patients with reflux esophagitis of any grade.
R M Genta; S J Spechler; A F Kielhorn
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus / I.S.D.E     Volume:  24     ISSN:  1442-2050     ISO Abbreviation:  Dis. Esophagus     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8809160     Medline TA:  Dis Esophagus     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  10-7     Citation Subset:  IM    
Copyright Information:
© 2010 Copyright the Authors. Journal compilation © 2010, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.
Department of Gastrointestinal Pathology, Caris Research Institute, IrvingDepartments of Pathology Medicine, VA North Texas Health Care System, The University of Texas Southwestern Medical Center at Dallas, Texas, USA.
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