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PubMed This is a summary of 14 peer-reviewed journal articles Updated
Gastroenterology · Erosive Esophagitis

The LA Grading System for Esophageal Damage

At a Glance

The Los Angeles (LA) Classification System grades erosive esophagitis severity from A (mild) to D (severe) during an endoscopy. Grades B, C, and D offer conclusive proof of GERD, while Grade A is borderline. Your grade directly determines your medication strength and need for follow-up testing.

When a doctor performs an endoscopy to look at your esophagus, they use a standardized “scoring” system to describe the amount of damage they see. This is known as the Los Angeles (LA) Classification System [1].

The system grades the severity of erosive esophagitis (EE) from A (the most mild) to D (the most severe) based on the size and location of “mucosal breaks”—small sores or erosions in the lining of the esophagus [1][2].

Understanding the Grades (A to D)

The grade you are assigned depends on how much of the esophageal lining is affected:

Grade Visual Criteria What it Means
Grade A One or more mucosal breaks, none longer than 5 millimeters (mm) [1]. Considered “mild” or borderline disease [3].
Grade B At least one break longer than 5 mm, but they do not connect the tops of two mucosal folds [1]. Clear evidence of acid damage and “conclusive” GERD [4].
Grade C Breaks that extend between the tops of two or more mucosal folds, but involve less than 75% of the circumference [1]. Severe disease; carries a higher risk of complications [5].
Grade D Breaks that involve 75% or more of the esophageal circumference [1]. Very severe disease; requires intensive, long-term management [6].

The “Minimal Change” (LA-M) Mystery

You might see “LA-M” or “minimal changes” mentioned in some reports. This refers to subtle redness (erythema) or slight blurring of the tissue lines without any actual physical breaks [7].

Importantly, LA-M is not part of the formal grading system used by the current Lyon Consensus 2.0 [7]. This is because these subtle changes are very difficult for different doctors to agree on—a problem called “poor inter-observer agreement” [8]. Research shows that Grade M often behaves just like a normal esophagus, so it is generally not treated as erosive disease [9].

Why Your Grade Matters for Treatment

The LA grade isn’t just a label; it directly influences how your care team manages your condition:

  1. Diagnostic Certainty: Under the Lyon Consensus 2.0, Grades B, C, and D are considered conclusive proof that you have Gastroesophageal Reflux Disease (GERD) [3][10]. If you have Grade A, the diagnosis is considered “borderline,” and your doctor may want a 24-hour pH test to confirm that acid is truly the culprit [4][10].
  2. Medication Strength: While Grade A might be managed with standard-dose Proton Pump Inhibitors (PPIs), Grades C and D often require double doses or newer, more potent medications called Potassium-Competitive Acid Blockers (P-CABs) like vonoprazan to ensure the tissue heals [11][12].
  3. Follow-Up Endoscopy: If you are diagnosed with Grade C or D, guidelines often recommend a repeat endoscopy after 8 weeks of treatment. This is to ensure the tissue has fully recovered and to double-check for underlying conditions like Barrett’s Esophagus that might have been hidden by the inflammation [6][13].

By knowing your grade, you can better understand your prognosis and the steps necessary to protect your esophagus from long-term damage [14].

Back to Home

Common questions in this guide

What does LA Grade A esophagitis mean on my endoscopy report?
LA Grade A means you have one or more small mucosal breaks in your esophagus, none longer than 5 millimeters. It is considered borderline or mild disease, and your doctor may recommend a 24-hour pH test to confirm if acid is the true cause of your symptoms.
Is LA Grade B considered conclusive GERD?
Yes, under current medical guidelines, Grade B provides clear, conclusive evidence of gastroesophageal reflux disease (GERD). It means your doctor saw at least one mucosal break longer than 5 millimeters in your esophagus.
Why do I need a follow-up endoscopy for Grade C or D esophagitis?
If you are diagnosed with severe esophagitis (Grade C or D), doctors usually recommend a repeat endoscopy after eight weeks of treatment. This confirms the tissue has completely healed and checks for underlying conditions like Barrett's Esophagus that the inflammation may have hidden.
Will my LA grade change my medication strength?
Yes, your LA grade directly impacts your treatment plan. Mild cases (Grade A) might be managed with a standard-dose proton pump inhibitor (PPI), while severe cases (Grades C and D) often require double doses or newer, more potent medications like vonoprazan to ensure the tissue heals.
What does 'LA-M' or 'minimal change' mean?
LA-M stands for minimal change and refers to slight redness or blurring of the tissue without any actual physical breaks. It is not part of the formal grading system because it often behaves like a normal esophagus and doctors frequently disagree on its presence.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on the LA grading in my report, do I have 'conclusive' GERD or should we perform a pH test to be sure?
  2. 2.Why was my esophagitis graded as 'A' or 'B' rather than 'M'? What were the specific mucosal breaks you saw?
  3. 3.Since I have Grade C or D, should we schedule a follow-up endoscopy in 8 weeks to confirm the tissue has fully healed?
  4. 4.Given my grade, is a standard dose of PPI enough, or should we consider a double dose or a PCAB like vonoprazan?

Questions For You

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Related questions

What Does LA-M Esophagitis Mean and How Is It Treated?

References

References (14)
  1. 1

    Endoscopy - esophagography.

    Horikoshi T

    Nihon rinsho. Japanese journal of clinical medicine 2016; (74(8)):1280-1284.

    PMID: 30562429
  2. 2

    Comparison of Los Angeles Grades of Erosive Esophagitis Scored by Local Investigators vs Central Adjudicators in a Clinical Trial.

    Spechler SJ, Laine L, DeVault KR, et al.

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2024; (22(12)):2526-2528.e1 doi:10.1016/j.cgh.2024.05.007.

    PMID: 38777170
  3. 3

    The Los Angeles-B esophagitis is a conclusive diagnostic evidence for gastroesophageal reflux disease: the validation of Lyon Consensus 2.0.

    Chen J, Dong P, Chen S, et al.

    Gastroenterology report 2025; (13()):goaf004 doi:10.1093/gastro/goaf004.

    PMID: 40083682
  4. 4

    Ambulatory pH-Impedance Findings Confirm That Grade B Esophagitis Provides Objective Diagnosis of Gastroesophageal Reflux Disease.

    Visaggi P, Del Corso G, Gyawali CP, et al.

    The American journal of gastroenterology 2023; (118(5)):794-801 doi:10.14309/ajg.0000000000002173.

    PMID: 36633477
  5. 5

    2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease.

    Jung HK, Tae CH, Song KH, et al.

    Journal of neurogastroenterology and motility 2021; (27(4)):453-481 doi:10.5056/jnm21077.

    PMID: 34642267
  6. 6

    Gastroesophageal Reflux Disease: A Review.

    Maret-Ouda J, Markar SR, Lagergren J

    JAMA 2020; (324(24)):2536-2547 doi:10.1001/jama.2020.21360.

    PMID: 33351048
  7. 7

    [Minimal Change Esophagitis].

    Ryu HS, Choi SC

    The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 2016; (67(1)):4-7 doi:10.4166/kjg.2016.67.1.4.

    PMID: 26809625
  8. 8

    Inter-observer variability of experts and trainees for the diagnosis of reflux esophagitis: Comparison of linked color imaging, blue laser imaging, and white light imaging.

    Lee SP, Kae SH, Jang HJ, et al.

    Journal of digestive diseases 2021; (22(7)):425-432 doi:10.1111/1751-2980.13023.

    PMID: 34036751
  9. 9

    Clinical significance of gastroesophageal reflux disease with minimal change: a multicenter prospective observational study.

    Manabe N, Joh T, Higuchi K, et al.

    Scientific reports 2022; (12(1)):15036 doi:10.1038/s41598-022-19408-w.

    PMID: 36057730
  10. 10

    Updates to the modern diagnosis of GERD: Lyon consensus 2.0.

    Gyawali CP, Yadlapati R, Fass R, et al.

    Gut 2024; (73(2)):361-371 doi:10.1136/gutjnl-2023-330616.

    PMID: 37734911
  11. 11

    The potential role of potassium-competitive acid blockers in the treatment of gastroesophageal reflux disease.

    Scarpignato C, Hunt RH

    Current opinion in gastroenterology 2019; (35(4)):344-355 doi:10.1097/MOG.0000000000000543.

    PMID: 31045597
  12. 12

    Long-term outcomes of patients with symptomatic gastroesophageal reflux disease treated with vonoprazan.

    Shinozaki S, Osawa H, Kobayashi Y, et al.

    Scandinavian journal of gastroenterology 2018; (53(8)):897-904 doi:10.1080/00365521.2018.1486883.

    PMID: 30056768
  13. 13

    Quality of life and severity of symptoms among patients with various degrees of reflux esophagitis: a prospective study.

    Mari A, Na'amnih W, Ghantous L, et al.

    Scientific reports 2023; (13(1)):13970 doi:10.1038/s41598-023-41332-w.

    PMID: 37634042
  14. 14

    The management of gastro-oesophageal reflux disease.

    Keung C, Hebbard G

    Australian prescriber 2016; (39(1)):6-10 doi:10.18773/austprescr.2016.003.

    PMID: 27041798

This page explains the LA Grading System for educational purposes. Your gastroenterologist is the best source for interpreting your endoscopy results and planning your treatment.

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