Figure 2  .

Major management pathways for patients known to have Los Angeles grades C and D oesophagitis. The pathways shown do not take into account the special (and controversial) needs for management of Barrett's oesophagus (statements 28, 29, and 53). Costs are minimised by the use of symptom response for guidance on the success or failure of therapy, rather than endoscopy (statement 62). Symptom control is defined in this setting as the reduction of symptoms to a level that does not impair health related quality of life (statements 11 and 62). For explanation of the exclusive use of proton pump inhibitors (PPI) in this patient category, see the section of text entitled "Management pathways in patients with severe oesophagitis (Los Angeles grades C and D)". Anti-reflux surgery is an appropriate option at any point in the pathway, subject to patient preference and surgeon skill (statements 63-65), but especially should be considered once the patient has been evaluated by initial management strategies.