Proton-Pump Inhibitor Therapy in Patients with Erosive Esophagitis: A Real-World Scenario

Abstract

Background: Gastroesophageal reflux disease (GERD) has three classical phenotypes, namely erosive esophagitis (EE), nonerosive reflux disease, and Barrett’s esophagus. Patients with GERD are managed with lifestyle changes, dietary interventions, and proton-pump inhibitors (PPI). Aim: To determine the patterns of PPI use in patients with documented EE. Methods: This prospective study recruited all patients with symptoms of GERD (heartburn and/or regurgitation with or without chest pain) and documented significant reflux esophagitis (Los Angeles grading LA-B or beyond on endoscopy). Lifestyle and dietary changes were initiated and all patients were prescribed twice daily PPI for 8 weeks. PPI was tapered as the requirement beyond 8 weeks. Follow-up was done at weeks 8, 12, and 24. The outcomes analysed included number of patients where complete PPI withdrawal was possible at week 24 and determinants of continued PPI use at 24 weeks of therapy. Statistical analysis was performed using Chi-square test, Mann–Whitney U-test, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. P < 0.05 was considered statistically significant. Results: The study cohort included 53 patients-42 with reflux esophagitis LA-B and 11 with reflux esophagitis LA-C (median age 46 years [22–77 years]; 28 [52.3%] males). There was significant difference in consumption pattern of PPI between week 12 and 24 (P = 0.008). At week 12, 15.1% were off PPI and 67% required intermittent dosing. At week 24, 45.3% of cases were off PPI therapy and 43.4% required intermittent dosing. Only 11.3% patients continued drug use at once a day dosing. Lower body mass index (BMI) (P 0.01) and age (P 0.01) were linked with complete PPI withdrawal at week 24. Conclusion: The present study highlights that PPI withdrawal is possible in 15.1% and 45.3% cases with EE after week 12 and week 24 of therapy, respectively. Lower BMI and age are likely to be associated with PPI withdrawal at week 24.