Grades Of Erosive Esophagitis Research Articles

Quality of life and severity of symptoms among patients with various degrees of reflux esophagitis: a prospective study

Gastro-esophageal reflux disease (GERD) can cause erosive esophagitis (EE) and compromise the quality of life (QoL). We examined differences in symptom severity and QoL according to EE severity grade. A follow-up study was conducted among GERD patients at the Nazareth Hospital in Israel. Patients underwent a baseline gastroscopy in 2014–2020 during which the EE grade was determined using the Los Angeles classification. Follow-up telephone interviews were conducted during 2019–2020 with a mean time interval of 18.9 months (SD = 14.9) after the baseline gastroscopy to assess GERD symptoms using the Reflux disease questionnaire (RDQ) and QoL using the GERD QoL questionnaire. The patients were interviewed in their native language (Arabic or Hebrew). Overall, 149 (66.4% males) patients were included; 50 had EE grades C/D and 99 had grades A/B. The mean age at baseline and follow-up was 44.6 years (SD = 15.1) and 46.2 years (SD = 14.9), respectively. Cronbach’s alpha was 0.928 and 0.855 for the RDQ and QoL questionnaires, respectively. Patients with EE C/D grades had more severe symptoms than patients with EE A/B grades (P = 0.05), especially in regurgitation scores (P = 0.03). Females had more severe symptoms (overall) than males (adjusted OR = 2.34; 95% CI 1.12–4.90). Patients with the more severe esophagitis EE C/D group (adjusted OR = 1.98; 95% CI 0.93–4.24) and those who used PPIs treatment (adjusted OR = 2.19; 95% CI 0.95–5.01) reported more severe GERD symptoms. The number of schooling years was significantly associated with better QoL score (beta coefficient 1.33, P = 0.005) but not EE grade or GERD symptoms. Follow-up endoscopy conducted among 22 patients with EE grades C/D showed that 13 (59.1%) of these patients had normal endoscopic findings, 6 patients (27.3%) had a grade A EE, 1 patient (4.5%) had grade B, and 2 (9.1%) remained with grade C EE. The Arabic and Hebrew versions of the RDQ and QoL questionnaires were highly reliable. GERD symptoms severity was more profound among patients with more severe esophagitis. No significant association between EE grade and QoL; this negative result might be due to the improvement in esophagitis endoscopic findings among patients with C/D grade.

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

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).

The Natural Course of Gastroesophageal Reflux Disease: A Critical Appraisal of the Literature.

Interpreting natural course studies have been very difficult due to their retrospective design, lack of standardization, reliability of reported mucosal findings, liberal use of antireflux medications and accuracy of chart documentation. Studies provided a wide range of progression rates of patients from nonerosive reflux disease (NERD) to erosive esophagitis (EE). However, direct progression from NERD to Barrett's esophagus appears to be an uncommon phenomenon. Importantly, progression of NERD patients was commonly reported to low grades of EE, which are currently considered inconclusive of gastroesophageal reflux disease. Reports of progression rates from low grades to high grades EE also vary considerably. Progression of patients with EE, without metaplastic epithelium underneath the inflammation, to Barrett's esophagus is relatively uncommon. Recently, it was also recognized that regression from high grades to low grades EE and from EE to NERD is a common phenomenon affecting up to 25% of the patients from each group.

Erosive Esophagitis Portends a Benign Clinical Course in the Majority of Patients

Indefinite proton pump inhibitor (PPI) therapy and endoscopic evaluation for Barrett's esophagus is recommended for erosive esophagitis (EE). However, the clinical course of EE remains undefined. Adults with EE on esophagogastroduodenoscopy (EGD) were identified at Mayo Clinic Rochester between January 2003 and September 2005. Patients with repeat EGD performed after index endoscopy were included. Patients with a history of upper gastrointestinal surgery, esophageal cancer, achalasia, or Barrett's on initial EGD were excluded. Of 219 patients identified, 98 had LA grade A, 72 LA grade B, and 49 LA grade C esophagitis. Persistent EE was found in 27% on repeat endoscopy. No patients progressed to more severe grades of esophagitis. While discontinuation of PPI was associated with persistent esophagitis, long-term healing of esophagitis occurred in the majority of patients despite discontinuation of PPI. Grade A or B esophagitis and the absence of hiatal hernia were also independent predictors of esophagitis healing on multivariate analysis. The rate of Barrett's esophagus was similar among patients with LA grade A/B and C esophagitis on initial EGD (5% vs. 14%, p = 0.6). The majority of patients with EE demonstrated healing at follow-up endoscopy regardless of continued PPI use. A small proportion developed Barrett's esophagus, including those with LA grade A and B esophagitis, highlighting a potential role for repeat endoscopy in all grades of EE. A more conservative long-term PPI strategy may be reasonable in patients with LA grade A or B esophagitis in the absence of hiatal hernia.

A randomized, double-blind study to evaluate the acid-inhibitory effect of vonoprazan (20 mg and 40 mg) in patients with proton-pump inhibitor-resistant erosive esophagitis.

Background:Standard treatment for patients with erosive esophagitis (EE) is proton-pump inhibitors (PPIs), but some patients are resistant to PPIs. We aimed to evaluate the acid-inhibitory effects and efficacy of a novel potassium-competitive acid blocker (vonoprazan) in patients with PPI-resistant EE.MethodsThis randomized, double-blind, multicenter study of vonoprazan evaluated gastric and esophageal pH over a 24-hour period as the primary endpoint and EE healing rate as the secondary endpoint. Following a 7 to 14-day run-in period (lansoprazole 30 mg treatment), patients with endoscopically confirmed PPI-resistant EE received vonoprazan 20 mg or 40 mg for 8 weeks.ResultsPatients were randomized to receive vonoprazan 20 mg (n = 9) or 40 mg (n = 10). Over a 24-hour period; both groups showed a significant increase from baseline in the percentage of time gastric pH ≥ 4, referred to as pH 4 holding time ratio (HTR): an increase from 73.21% to 96.46% in the 20 mg group, and from 69.97% to 100.00% in the 40 mg group. Increases from baseline in esophageal pH 4 HTRs were not significant. The 40 mg group showed greater increases in gastric and esophageal pH 4 HTRs compared with the 20 mg group, but differences between groups were not significant. After 8 weeks’ treatment, the healing rate in subjects with baseline EE grades A–D was 60.0% (3/5 patients) in the 20 mg group and 71.4% (5/7 patients) in the 40 mg group. Vonoprazan was generally well tolerated. One patient (40 mg group) experienced four treatment-emergent adverse events (TEAEs) (unrelated to study drug), leading to study discontinuation.ConclusionsVonoprazan 20 mg and 40 mg effectively inhibited gastric acid secretion over a 24-hour period with significantly increased gastric pH 4 HTR, and resulted in an EE healing rate > 60.0% in this study. Vonoprazan treatment may be valuable for patients with PPI-resistant EE

Correlation Between Gastroesophageal Reflux Disease Questionnaire and Erosive Esophagitis in School-aged Children Receiving Endoscopy

The gastroesophageal reflux disease (GERD) questionnaire (GerdQ) is a validated questionnaire that was developed recently to help identify GERD patients. The sensitivity and specificity of GerdQ for the diagnosis of GERD in adult patients were 65% and 71%, respectively. Because the application of GerdQ in pediatric population is largely unknown, the aim of this study is to establish the endoscopic correlation between Chinese GerdQ and grades of erosive esophagitis (EE) in Taiwanese children. Seventy-four children (aged 9-18 years) were evaluated by our version of the Chinese GerdQ prior to receiving esophagogastroduodenoscopy for warning upper gastrointestinal symptoms. Grades of EE were assessed blindly, according to the Los Angeles classification. The sensitivity and specificity of GerdQ for detecting endoscopic EE were analyzed. In 74 patients, the male to female ratio was 1:1.1 and the mean age was 14.2 ± 2.3 years (age range: 9.2-17.9 years). Thirty-nine percent of the enrolled patients had EE. The sensitivity and specificity of GerdQ (with a cutoff score of ≥7) to identify EE patients were 65.5% and 80%, respectively. The odds ratio of GerdQ for a cutoff score of 7 to identify EE was 7.6 (95% confidence interval = 2.6-21.9, p < 0.001). For the identification of EE in children, the Chinese GerdQ had similar sensitivity and specificity to that used for adults. This questionnaire may be applied as a noninvasive screening tool.

Dexlansoprazole in the Treatment of Esophagitis and Gastroesophageal Reflux Disease

To describe the pharmacology, pharmacokinetics, and efficacy of dexlansoprazole in the treatment of heartburn associated with nonerosive gastroesophageal reflux disease (GERD) and healing and maintenance of healing of all grades of erosive esophagitis (EE). Literature searches were conducted using MEDLINE Ovid (1950-December 2009, week 4) and EMBASE (1980-2009, week 53) using the term dexlansoprazole. References from articles obtained from the search were evaluated for other relevant citations. All articles published in English evaluating the pharmacology, pharmacokinetics, efficacy, and adverse effect profile of dexlansoprazole were selected for inclusion. Dexlansoprazole is the newest addition to the proton pump inhibitor (PPI) class and is approved for the treatment of heartburn associated with nonerosive GERD, healing of all grades of EE, as well as maintenance of healing of EE. Dexlansoprazole has a unique dual delayed-release formulation, which releases drug at 2 points in time; the first peak occurs 1-2 hours after administration and the second occurs within 4-5 hours after administration. In Phase 3 trials conducted in adults, researchers found that dexlansoprazole increases rates of healing of EE, as well as the maintenance of healing, compared to lansoprazole. Relief of heartburn symptoms was comparable among the dexlansoprazole and lansoprazole treatment groups. Common adverse effects of dexlansoprazole are similar to those of the other PPIs, including diarrhea, abdominal pain, nausea, upper respiratory infection, vomiting, and flatulence. Dexlansoprazole provides another treatment option for the management of EE and symptoms of heartburn. Considering that the cost of dexlansoprazole is not favorable, further studies evaluating potential advantages over other agents are necessary to define the role of dexlansoprazole in the treatment of these conditions.

Lower Rates of Healing of Erosive Esophagitis (EE) in Nonwhite GERD Patients

Purpose: To test for an association of race with healing of different grades of EE in GERD patients treated with once-daily PPIs. Methods: This post hoc analysis pooled data from 5 similarly designed, double-blind, multicenter RCTs of esomeprazole 40 mg vs omeprazole 20 mg (SH-QBE-0013, −0016, −0052) or lansoprazole 30 mg (D9612C00083, D9612L00046) for EE healing. Eligible adults had endoscopically verified EE, graded using the Los Angeles (LA) classification system. PPIs were given 30–60 min before breakfast. Endoscopy was repeated at wk 4 and 8 to assess EE status; patients healed (ie, no mucosal breaks) at wk 4 exited the study. EE healing rates are tabulated below by baseline LA grade (A-D) and self-reported race data (white or nonwhite [ie, all other reported races]). A proportional odds model tested for an association of race with baseline LA grade. Logistic regression models (LRMs) were fit with EE healing as the dependent variable and race as an independent variable. The LRM adjusted for treatment, study, baseline LA grade, age, sex, BMI, H pylori status, and hiatal hernia. A second LRM tested for interaction of race with the other factors. Results: Mean age of the 11,027 patients was 47 y (59% men; 91% white). Nonwhite patients had less severe baseline EE (ie, LA grades A or B) (P < .0001; adjusted odds ratio [OR], 0.69 [95% CI, 0.61–0.79]). Race had a significant effect on wk-8 EE healing (P= .001; OR [nonwhite vs white], 0.75 [95% CI, 0.63–0.89]; Table). Less severe baseline LA grade, treatment, and increasing age (P < .0001 for each) and hiatal hernia (P= .0009) were associated with higher odds of EE healing; these factors had no significant interactions with race. Conclusion: After adjustment for treatment, study, baseline LA grade, age, sex, BMI, H pylori status, and hiatal hernia, nonwhite patients were less likely to have healed EE after 8-wk PPI therapy, a finding worthy of further study.Table. EE: healing rates (95% CI) by race and baseline LA grade (N = 11,027)

Is Obesity the Cause of Reduced Healing Rates in Advanced Grades of Erosive Esophagitis (EE)?

Is Obesity the Cause of Reduced Healing Rates in Advanced Grades of Erosive Esophagitis (EE)?

Risk Factors for the Severity of Erosive Esophagitis in Helicobacter pylori -Negative Patients with Gastroesophageal Reflux Disease

Background: The risk factors for the varying grades of erosive esophagitis (EE) severity could be better understood. For that reason, we evaluated the risk factors associated with EE in patients with gastroesophageal reflux disease. Methods: We determined the presence and severity of EE (using the Los Angeles Classification) in patients with negative serology Helicobacter pylori who underwent esophago-gastroduodenoscopy as part of screening in four prospective, multicenter, randomized, double-blind comparative trials of once-daily esomeprazole and omeprazole for the acute healing of erosive esophagitis. We also examined the baseline characteristics of enrolled patients, and identified risk factors for severe disease using a multivariable logistic regression model. Results: Erosive esophagitis was documented in 6709 patients of a total of 10,294 patients who underwent endoscopy; of these, 34% had grade A, 39% had grade B, 20% had grade C, and 7% had grade D disease. The majority of patients were male (61%) and Caucasian (93%) with a mean age of 46 years. In the regression model, the following were significant independent risk factors for severe (grades C and D) versus mild erosive esophagitis (grades A and B): severe heartburn (adjusted odds ratio 1.79); prolonged heartburn >5 years in duration (1.16); obesity (1.21); the presence of hiatus hernia (2.13); male gender (1.97); and Caucasian ethnicity (1.53). Conclusion: In this large sample of patients with predominantly H. pylori -negative gastroesophageal reflux disease, risk factors for severe erosive esophagitis were the duration and severity of heartburn, and obesity.