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McDonagh MS, Carson S, Thakurta S. Drug Class Review: Proton Pump Inhibitors: Final Report Update 5 [Internet]. Portland (OR): Oregon Health & Science University; 2009 May.

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Drug Class Review: Proton Pump Inhibitors: Final Report Update 5 [Internet].

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Appendix E. Esophagitis grading scales used in randomized controlled trials

Savary-Miller

Grade I: one or more supravestibular, non-confluent reddish spots, with or without exudate.

Grade II: erosive and exudative lesions in the distal esophagus which may be confluent, but not

Grade III: circumferential erosions in the distal esophagus, covered by hemorrhagic and pseudomembranous exudates.

Grade IV: presence of chronic complications such as deep ulcers, stenosis, or scarring with Barrett’s metaplasia.

Modified Hetzel-Dent

Grade 0: Normal mucosa, no abnormalities found

Grade 1: No macroscopic erosions, but presence of erythema, hyperemia, and/or friability of the esophageal mucosa.

Grade 2: Superficial ulceration or erosions involving less than 10% of the mucosal surface area of the last 5 cm of esophageal squamous mucosa.

Grade 3: Superficial ulceration or erosions involving greater than or equal to 10% but less than 50% of the mucosal surface area of the last 5 cm of esophageal squamous mucosa.

Grade 4: Deep ulceraton anywhere in the esophagus or confluent erosion of more than 50% of the mucosal surface area of the last 5 cm of esophageal squamous mucosa.

Grade 5: Stricture, defined as a narrowing of the esophagus that does not allow easy passage of the endoscope without dilation.

Los Angeles Classification

Not present: No breaks (erosions) in the esophageal mucosa (edema, erythema, or friability may be present)

Grade A: One or more mucosal breaks confined to the mucosal folds, each not more than 5 mm in maximum length.

Grade B: One or more mucosal breaks more than 5 mm in maximum length, but not continuous between the tops of two mucosal folds.

Grade C: Mucosal breaks that are continuous between the tops of tow or more mucosal folds, but which involve less that 75% of the esophageal circumference.

Grade D: Mucosal breaks which involve at least 75% of the esophageal circumference.

The presence or absence of strictures, ulcers, and/or Barrett’s esophagus much be noted separately, e.g., “Grade B with stricture”.

Criteria used in Hatlebakk, 1993:

Grade 1: red streaks or spots along the ridge of the folds in the distal esophagus, covered or not by fibrinous Exudate

Grade 2: Broader lesions, each involving the entire width of a fold or coalescing into fields or erythema, covered or not with fibrinous exudates

Grade 3: Stricture or endoscopically visible ulcer in distal esophagus.

Criteria used in Castell, 1996, Howden, 2002, Richter 2001b:

Grade 0: normal-appearing mucosa

Grade 1: mucosal edema, hyperemia, and/or friability

Grade 2: one or more erosions/ulcerations involving <10% of the distal 5 cm of the esophagus

Grade 3: erosions/ulcerations involving 10–50% of the distal 5 cm of the esophagus or an ulcer 3–5 mm in diameter. In cases of Barrett’s esophagus, the area 5 cm proximal to the squamocolumnar junction was evaluated

Grade 4: multiple erosions involving >50% of the distal 5 cm of the esophagus or a single ulcer > 5mm in diameter.

Copyright © 2009, Oregon Health & Science University, Portland, Oregon.
Bookshelf ID: NBK47264

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