Inter- and intra-observer variability of the Los Angeles classification: A reassessment

Siavosh Nasseri-Moghaddam, Hadi Razjouyan, Mehdi Nouraei, Maysam Alimohammadi, Mansoureh Mamarabadi, Homayoon Vahedi, Akram Pourshams, Mehdi Mohammadnejad, Farhad Zamani, Farhad Sadr, Sodaif Darvish-Moghaddam, Pantea Farsi, Reza Malekzadeh

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Background: Los Angeles classification is widely adopted for reporting endoscopic gastroesophageal reflux disease. We assessed the inter- and intra-observer variability of the Los Angeles classification. Methods: Still images (n = 254) of the lower esophagus were presented to 9 gastroenterologists (6 experts and 3 trainees) and they were asked to report the images according to the Los Angeles classification. After 2 weeks the images were reordered and they were asked to report them again. Kappa statistic was calculated for intra- and inter-observer variability. Results: The kappa for intra-observer agreement, was 0.54 (attendings: 0.54; trainees; 0.55; P = not significant) and the inter-observer agreement was 0.22 (attendings: 0.20; trainees: 0.31; P = 0.027). The inter- and intra-observer kappa values in differentiating nonerosive from erosive cases were 0.22 (attendings: 0.21; trainees: 0.31, P = not significant) and 0.57 (aftendings: 0.58; trainees: 0.55, P = not significant), respectively. Conclusion: According to our data, the Los Angeles classification has acceptable intraobserver variability, both for detecting presence or absence of erosions and for differentiating between different degrees of esophagitis, while its inter-observer performance seems to be less acceptable. It may be reasonable and timely to have another look at the Los Angeles classification to see whether its performance can be improved even further.

Original languageEnglish (US)
Pages (from-to)48-53
Number of pages6
JournalArchives of Iranian Medicine
Issue number1
StatePublished - Jan 2007

All Science Journal Classification (ASJC) codes

  • General Medicine


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