Conditions / Erosive Esophagitis
Los Angeles Grade A–D Erosive Esophagitis
Affects an estimated 22% of GERD patients
Overview
Erosive esophagitis means the esophageal lining has been physically damaged by chronic acid. The Los Angeles Classification grades severity: Grade A (small breaks <5mm), B (breaks >5mm), C (merging breaks), D (severe circumferential erosion). Grades C–D are serious medical conditions.
How it's diagnosed
Upper endoscopy (EGD) with biopsy. Biopsies rule out Barrett's and eosinophilic esophagitis. Grades C and D require repeat endoscopy after 8–12 weeks of PPI therapy.
Triggers
- All GERD triggers cause direct mucosal damage
- NSAIDs are particularly dangerous
- Alcohol causes direct mucosal injury
- Lying flat after eating
- Any acid exposure is more damaging on eroded tissue
Symptoms
- Heartburn (often severe)
- Painful swallowing (odynophagia)
- Food sticking in chest
- Severe chest pain
- Vomiting blood (severe)
- Anemia from chronic bleeding (grades C–D)
Complications if untreated
- Barrett's esophagus (highest risk group)
- Esophageal stricture requiring dilation
- Bleeding requiring endoscopic treatment
- Esophageal perforation (rare)
Immediate relief
- Nothing by mouth if bleeding symptoms
- Elevate head of bed
- Liquid or soft diet during acute phase
- Twice-daily PPI as directed
Long-term management
- Aggressive PPI therapy (grades C–D: 2× daily 3+ months)
- Strict dietary compliance
- Repeat endoscopy to confirm healing
- Regular surveillance
Diet
Strict liquid or soft diet during healing. Avoid ALL spicy, acidic, rough-textured foods. Progress: liquids → soft → regular diet over 4–6 weeks.
When to see a doctor
THIS REQUIRES MEDICAL TREATMENT. Grades C and D are medical emergencies. See gastroenterologist immediately. Do not self-manage.
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