S490 A Single Center Experience in the Management and Follow-Up of Patients With Esophagitis: A Retrospective Study

Abstract

Introduction: Gastroesophageal reflux disease (GERD) is a chronic condition in which the reflux of gastric content into the esophagus results in symptoms and complications, such as erosive esophagitis, Barrett’s esophagus (BE), and esophageal adenocarcinoma. There are four grades of esophagitis increasing in severity from A to D. In patients with esophagitis on initial endoscopic evaluation, the current American College of Gastroenterology (ACG) guidelines recommend repeat esophagogastroduodenoscopy (EGD) after a minimum 8-week of proton pump inhibitor (PPI) therapy, to ensure healing of esophagitis and to determine the presence of BE. Our objectives were to characterize patients with esophagitis who presented to Saint Louis University Hospital (SLUH), understand practice patterns, and identify variables that predict disease progression and affect clinical outcomes. Methods: We identified 256 patients who presented to SLUH for EGD for any indication between 2012 and 2018 and were found to have endoscopic diagnosis of esophagitis. Laboratory and pathologic data were reviewed for initial and follow-up endoscopy. All categorical variables were analyzed by chi-square analysis. Analysis of variance (ANOVA) and t-tests were used for continuous data, and analysis was performed using SPSS version 27.0. Results: Out of the 256 patients who were diagnosed with esophagitis, 61 were classified as Grade A, 59 Grade B, 45 Grade C and 91 Grade D. The mean age was 59 ± 15 and the mean BMI was 27.3 ± 8. PPI prescription percentage, repeat EGD and outcomes are shown in Table. There was no statistically significant association between sex, ethnicity, smoking history, or alcohol use history and development of BE. Conclusion: Our study showed under-prescription of PPI in patients with esophagitis. Repeat EGD was only recommended for 28%, 32%, 49% and 57% of the patients with Grades A, B, C and D esophagitis, respectively. Stronger efforts should be taken to help adhere to the guidelines in prescribing acid-suppressive medications and recommending repeat EGD for patients with esophagitis. Development of esophageal cancer was the highest in those with Grade D esophagitis. Larger studies are needed to evaluate the risk of BE or dysplasia in patients with Grades A and B esophagitis and to provide additional data on rates of development of BE or esophageal cancer in the respective groups. Table 1. - Results of a single-center study on PPI prescription percentage, repeat EGD and outcomes in patients with endoscopic diagnosis of esophagitis Grade of esophagitis PPI treatment recommended Repeat EGD recommended Repeat EGD performed Barrett’s esophagus present on follow up Dysplasia present on follow up Esophageal cancer present on follow up A (N=61) 51 (84%) 17 (28%) 6 (35%) 2 (3.3%) 2 (3.3%) 1 (1.6%) B (N=59) 40 (68%) 19 (32%) 4 (21%) 3 (5.1%) 1 (1.7%) 1 (1.7%) C (N=45) 38 (84%) 22 (49%) 3 (14%) 1 (2.2%) 1 (2.2%) 1 (2.2%) D (N=91) 74 (81%) 52 (57%) 19 (37%) 8 (8.8%) 3 (3.3%) 5 (5.5%)