Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification
Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification
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DOI：
10.1136/gut.45.2.172
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发表时间：
1999-08-01
期刊：
影响因子：
24.5
通讯作者：
Wallin, L
中科院分区：
文献类型：
--
作者：
Lundell, LR;Dent, J;Wallin, L
背景 - 内镜下食管的改变对诊断有帮助，并能识别出有疾病慢性化风险的患者。然而，对于如何描述和分类反流性食管炎的表现，严重缺乏一致性。
目的 - 检验描述黏膜破损环周范围的标准的可靠性，并评估根据洛杉矶系统对食管炎进行分级的反流性疾病患者的功能和临床相关性。
方法 - 来自不同国家的46名内镜医师使用一份详细的工作表，对22名患有不同严重程度反流性食管炎患者的内镜视频记录进行评估。在单独的研究中，洛杉矶系统分级与24小时食管pH监测（178名患者）以及奥美拉唑治疗的临床试验（277名患者）相关联。
结果 - 根据黏膜破损是否延伸至黏膜皱襞顶部之间这一标准来评估食管炎的环周范围，观察者之间具有可接受的一致性（平均κ值为0.4）。洛杉矶系统采用了这种方法。另一种将黏膜破损的环周范围分组为占食管周长的0 - 25%、26 - 50%、51 - 75%、76 - 99%或100%的方法，除了范围最小的类别（平均κ值为0.4）外，观察者间的差异都高得不可接受（平均κ值为0 - 0.15）。食管酸暴露的严重程度显著（p<...此处原文似乎不完整）
Background-Endoscopic oesophageal changes are diagnostically helpful and identify patients exposed to the risk of disease chronicity. However, there is a serious lack of agreement about how to describe and classify the appearance of reflux oesophagitisAims-To examine the reliability of criteria that describe the circumferential extent of mucosal breaks and to evaluate the functional and clinical correlates of patients with reflux disease whose oesophagitis was graded according to the Los Angeles system.Methods-Forty six endoscopists from different countries used a detailed worksheet to evaluate endoscopic video recordings from 22 patients with the full range of severity of reflex oesophagitis. In separate studies, Los Angeles system gradings were correlated with 24 hour oesophageal pH monitoring (178 patients), and with clinical trials of omeprazole treatment (277 patients).Results-Evaluation of circumferential extent of oesophagitis by the criterion of whether mucosal breaks extended between the tops of mucosal folds, gave acceptable agreement (mean kappa value 0.4) among observers. This approach is used in the Los Angeles system. An alternative approach of grouping the circumferential extent of mucosal breaks as occupying 0-25%, 26-50%, 51-75%, 76-99%, or 100% of the oesophageal circumference, gave unacceptably high interobserver variation (mean kappa values 0-0.15) for all but the lowest category of extent (mean kappa value 0.4). Severity of oesophageal acid exposure was significantly (p