This protocol addresses gastroesophageal reflux disease (GERD) in patients with erosive reflux esophagitis classified as Los Angeles (LA) grade C or D — the more severe endoscopic grades, associated with significant mucosal injury and a higher risk of complications.
Erosive (reflux) esophagitis, Los Angeles grade C or D. These grades indicate extensive mucosal breaks, representing a high-risk subgroup where long-term management and endoscopic follow-up are essential.
Management involves ongoing use of a proton pump inhibitor (PPI) or, in appropriate cases, a surgical antireflux procedure — the specific regimen and the decision between these options are set out in the full protocol.
Confirmed healing of erosive esophagitis on follow-up endoscopy after treatment, including evaluation for complications that may be difficult to detect while severe mucosal inflammation is present.
DOI: 10.14309/ajg.0000000000001538
We recommend maintenance PPI therapy indefinitely or antireflux surgery for patients with Los Angeles grade C or D esophagitis.
Patients with LA grade C or D erosive esophagitis should remain on long-term PPI therapy to maintain healing.
In patients with LA grade C and D EE, endoscopy is recommended after PPI treatment to ensure healing and to evaluate for Barrett's esophagus, which can be difficult to detect when severe EE is present.
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