Comparison in Adherence to Treatment between Patients with Mild-Moderate and Severe Reflux Esophagitis: A Prospective Study.

Abstract

Purpose: Gastro-esophageal reflux disease (GERD) is prevalent and causes erosive esophagitis (EE) with varying degrees of severity (A to D according to the Los Angeles Classification). Adherence to medical therapy is crucial for treatment success. We compared adherence to treatment recommendations between patients with EE grades C/D and A/B. Methods: A follow-up study was conducted during 2019–2020 among GERD patients who underwent a diagnostic gastroscopy 1–4 years earlier. Telephone interviews were conducted with patients diagnosed with severe EE grades C/D (n = 99) and randomly selected patients with mild–moderate EE grades A/B (n = 50). Patients with grades A/B were classified as adherent if they took proton pump inhibitors (PPIs) for 2–3 months as recommended. Patients with grades C/D were classified as adherent if they took medications for a prolonged period (>6 months) and performed a follow-up endoscopy as recommended. Results: The mean age of the participants was 44.6 years (SD = 15.1). The mean duration of PPIs therapy in patients with EE grades A/B was 9.4 months (SD = 8.7). Fourteen (14.2%) patients with EE grades A/B were non-adherent to treatment, compared to 21 (40.8%) patients with EE grades of C/D: adjusted OR = 0.06; CI 95% 0.02–0.18, p < 0.001. Follow-up endoscopy was performed by 44% of EE–C/D patients. Unmarried patients compared to married ones were less adherent (adjusted OR = 0.23; 95% CI 0.08–0.69, p < 0.001). Conclusions: Patients with esophagitis (EE–A/B) were more adherent to medical therapy when compared to patients with more severe esophagitis (EE–C/D).