Clinical features and therapeutic responses to proton pump inhibitor in patients with severe reflux esophagitis: A multicenter prospective observational study.

Abstract

BACKGROUND AND AIM:

In patients with severe erosive reflux disease (ERD; Los Angeles classification grade C/D) who do not undergo endoscopic examination, insufficient strength and duration of proton pump inhibitor (PPI) therapy may lead to complications such as esophageal bleeding and stenosis. Therefore, to provide a safe and effective treatment for gastroesophageal reflux disease (GERD), we investigated the clinical features of patients with severe ERD and their responses to PPI therapy.

METHODS:

Patients with GERD symptoms received PPI therapy for 4 weeks after endoscopic examination. The patients completed the Gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test questionnaire before and 2 or 4 weeks after PPI treatment. Patient characteristics, presence/absence of coexisting atrophic gastritis (AG) and hiatus hernia (HH), and responses to PPI therapy were compared in patients with GERD among three groups (nonerosive reflux disease, mild ERD [grade A/B], and severe ERD).

RESULTS:

The severe ERD group had a significantly higher proportion of males, higher body mass index, and longer duration of GERD morbidity. Furthermore, the severe ERD group also had a significantly lower incidence of coexisting AG and higher incidence of HH. There was no difference in the severity of GERD before PPI treatment among the three groups. Unexpectedly, the response to PPI therapy was the best in the severe ERD group.

CONCLUSION:

Sufficient strength and period of PPI therapy are required, even if the symptoms show early improvement, when treating GERD patients without performing endoscopy, considering the possibility of severe ERD.

• Authors: Kimio Isshi, Nobuyuki Matsuhashi, Takashi Joh, Kazuhide Higuchi, Katsuhiko Iwakiri, Takeshi Kamiya, Noriaki Manabe, Tatsuya Nakada, Maiko Ogawa, Seiji Arihiro, Ken Haruma, Koji Nakada
• Journal: JGH open : an open access journal of gastroenterology and hepatology (JGH Open) Vol. 5 Issue 1 Pg. 99-106 (Jan 2021) ISSN: 2397-9070 [Electronic] Australia
• PMID: 33490619 (Publication Type: Journal Article)
• Copyright: © 2020 The Authors. JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.