Esomeprazole Therapy Research Articles

Risk factors for symptom relapse in patients with Los Angeles Grade A/B erosive esophagitis

AbstractRecurrence of reflux symptoms following discontinuing proton pump inhibitor therapy is a common problem in the treatment of gastroesophageal reflux disease. We aim (1) to examine the cumulative 12‐week incidence of symptom relapse following 8‐week proton pump inhibitor therapy in patients with Los Angeles grade A/B erosive esophagitis and (2) to search the risk factors predicting symptom relapse in the treatment of erosive esophagitis. From June 2010 to May 2019, patients with Los Angeles Grade A/B erosive esophagitis receiving esomeprazole therapy (40 mg qd) for 8 weeks followed by complete symptom resolution were included in this study. Subjects received on‐demand esomeprazole treatment for 12 weeks and underwent prospective follow‐up for reflux symptoms. 12‐week cumulative incidence of symptom relapse was assessed, and predictive risk factors for symptom relapse were determined by multivariate analysis. 219 patients with Los Angeles Grade A/B erosive esophagitis who achieved complete symptom resolution following 8‐week esomeprazole therapy were enrolled. During the 12‐week follow‐up period, 110 patients (50.2%) developed symptom relapse. Univariate analysis showed that symptom relapse was significantly associated with advanced age, smoking, and the presence of heartburn (p = .003, .015, and .042, respectively). Multivariate analysis with stepwise logistic regression showed that only advanced age (95% confidence interval [CI]: 1.45–5.15) and smoking (95% CI: 1.30–6.58) were independent factors predicting symptom relapse with odds ratios of 2.74 and 2.92, respectively. The 12‐week cumulative incidence of symptom relapse following initial proton pump inhibitor treatment in patients with Los Angeles grade A/B erosive esophagitis is 50.2%. Advanced age and smoking are independent risk factors predicting symptom relapse following treatment in patients with mild erosive esophagitis.

Intravenous metronidazole-, levofloxacin-containing triple therapy for treating patients with Helicobacter pylori-related active peptic ulcer complications: A pilot study.

The aim of this pilot study was to evaluate the efficacy and safety of intravenous use esomeprazole, metronidazole, and/or levofloxacin in the treatment of Helicobacter pylori (H.pylori)-associated peptic ulcer complications. Inpatients with peptic ulcer complications who were not able to take oral medicine were randomly assigned to three groups: triple therapy (esomeprazole, levofloxacin, metronidazole) and dual therapy (esomeprazole, levofloxacin/metronidazole) for 7 days. After intravenous treatment, all patients received open-label oral esomeprazole 20 mg bid for another 1 month. All subjects were followed up for gastroscopy at the seventh day of intravenous treatment to confirm the ulcer healing and 13 C-urea breath test to confirm successful H.pylori eradication 4-6 weeks after completion of oral esomeprazole therapy. The H.pylori eradication rate of both LEV-dual therapy (33.3%, 95% CI: 9.7%-70.0%) and MTZ-dual therapy (50%, 95% CI: 21.5%-78.5%) was significantly lower than that of triple therapy (95%, 95% CI: 71.1%-97.4%) (p=.003, .016). There were no significant differences in the adverse effects among all treatment groups, and the adverse effects were rare. The intravenous triple regimen, consisting of proton-pump inhibitor, metronidazole, and levofloxacin, could be considered in patients of H.pylori-associated peptic ulcer complications if oral medicine cannot be provided.

Effectivity of Esomeprazole Compared with Lansoprazole in the Treatment of Pediatric with Gastritis

BACKGROUND: The administration of proton pump inhibitor (PPI) therapy in pediatric patients has also increased dramatically during the last three decades. Clinical trials comparison of esomeprazole and lansoprazole for pediatric were limited. AIM: This study focused on comparing the effectivity of Esomeprazole with lansoprazole for healing gastritis symptoms in pediatric patients. METHODS: A randomized and single blind (assessors) controlled clinical trial was done at H. Adam Malik hospital at Medan. Patients that complied with study’s criteria and signed informed consent were collected information about the symptoms. Confirmation diagnosis of g astritis by gastroscopy, then randomized into lansoprazole treatment group (15 mg if < 30 kg and 30 mg if > 30 kg) or esomeprazole treatment group (0,4–0,8 mg per Kg body weight). Medication for both groups will be given orally for 14 day s, then evaluated for the initial symptoms. p -value of this study was calculated with the χ2 test. RESULTS: Fifty two patients confirmed gastritis were enrolled in this study; 27 patients received lansoprazole and 25 patients received esomeprazole. There was no difference of effectivity between the two groups for vomiting, hematemesis, and nausea. Lansoprazole treatment for 14 days has a significant difference for abdominal pain recovery from esomeprazole treatment. The lansoprazole groups have 92% free of abdominal pain compared to the esomeprazole group for only 66% free of abdominal pain. CONCLUSION: There was no significant difference between lansoprazole and esomeprazole therapy.

Efficacy and Safety of Esomeprazole for the Treatment of Reflux Symptoms in Patients with Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis.

Background:We investigated the efficacy of esomeprazole for the treatment of gastroesophageal reflux disease (GERD) in a meta-analysis of clinical trials results.Methods:Medline, Embase, PubMed and Web of Science databases were systematically searched for suitable studies, and double-blind, randomized controlled trials (RCTs) were involved. A meta-analysis of RCTs was performed to analyze the efficacy of esomeprazole on clinical outcomes that associated with the severity of GERD.Results:A total of 8 clinical trials were selected in our meta-analysis (N=4495, patients with GERD). Esomeprazole treatment yielded a significant improvement in clinical signs and symptoms of GERD compared to placebo group. Funnel plot and Egger test showed there was no significant bias in the publication. Cochrane collaboration tool and Jadad scale were used to indicate that all 8 RCTs were of high quality. The results of Galbraith radial plot showed that no study was the major source of heterogeneity. Esomeprazole treatment significantly decreased the relapse rates more than that of placebo group (RR = 0.729; 95% CI: 0.670 to 0.794; P<0.001). It seems to be lower rates of heartburn (RR = 0.747; 95%CI: 0.665–0.839; P <0.001) and epigastric pain (RR = 0.795; 95%CI: 0.679–0.932; P =0.005) in esomeprazole-treated group compared with the placebo group. Moreover, serious adverse events was less likely to happen after esomeprazole therapy (RR = 1.406, 95% CI: 1.030–1.918; P =0.032).Conclusion:Compared with the control group, esomeprazole is a promising therapeutic agent that improves the management of patients with GERD.

436 – The Efficacy of Fourteen-Days Esomeprazole and Amoxicillin Containing High Dose Dual Therapy in the Treatment of First-Line Anti-H. Pylori Therapy: A Prospective Randomized Trial

436 – The Efficacy of Fourteen-Days Esomeprazole and Amoxicillin Containing High Dose Dual Therapy in the Treatment of First-Line Anti-H. Pylori Therapy: A Prospective Randomized Trial

Analysis of the clinical features and prognostic factors of patients with gastroesophageal reflux disease

Objective To investigate the clinical features and prognostic factors of patients with gastroesophageal reflux disease(GERD). Methods The clinical data of 62 cases of GERD patients with esomeprazole therapy(GERD group) in the Central Hospital of Chaoyang from February 2012 to December 2015 was analyzed, and 65 cases of chronic superficial gastritis were served as control group.The Hamilton Depression Scale(HAMD) and Hamilton Anxiety Scale (HAMA) score of two groups were observed.The relationship between RDQ score, HAMD score and HAMA score in patients with GERD was analyzed, and the influence factors of the treatment efficacy were analyzed by Logistic. Results HAMD score, HAMA score of GERD group were (19.8 ±7.9) points, (15.9 ±5.6) points, and of control group were (7.9± 1.2) points, (6.7 ±1.0) points, the difference between the two groups was statistically significant(P<0.05 ). HAMD, HAMA and RDQ scores were positively correlated of GERD group(correlation coefficients were 0.401, 0.382, P<0.05). Two months after treatment with esomeprazole, there were 34 cases with markedly effective, 10 cases with effective, 18 cases with invalid, and the remission rate was 71%(44/62). Multivariate logistic regression analysis showed that non erosive peptic esophagitis(NERD)(OR=2.483, 95%CI: 1.247-4.944, P<0.05) and female(OR=2.421, 95% CI: 1.259-4.657, P<0.01) were the independent predictor of esomeprazole in the treatment. Conclusion GERD patients are accompanied by depression and anxiety and other psychological symptoms, the clinical symptoms of some patients with PPI treatment still cannot be alleviated.NERD subtype, female and depression anxiety are the main factors affecting the treatment effect. Key words: Gastroesophageal reflux disease; Non erosive gastro esophagitis; Reflux esophagitis; Esomeprazole; Logistic regression analysis

Issue Highlights

Issue Highlights

Effect of combined Metformin and Esomeprazole therapy on plasma gastrin and blood glucose in elderly patients with type 2 diabetes mellitus

Objective To investigate the effect of combined Metformin and esomeprazole therapy on plasma levels of gastrin, blood glucose, glycosylated hemoglobin(HbA1c)and insulin in elderly patients with type 2 diabetes. Methods A randomized, double-blind, placebo-controlled study of 41 elderly patients with type 2 diabetes was conducted.Patients were randomly assigned into treatment group(combination therapy with Metformin 0.5 g, bid or tid and Esomeprazole 20 mg, qd, for 12 weeks)and placebo group(Metformin monotherapy 0.5 g, bid or tid, for 12 weeks). Fasting blood samples were taken from vein before and after treatment.Fasting serum levels of gastrin, glucose, HbA1c, insulin, lipids, liver and renal functions were compared between the two groups.The homeostasis model of assessment for insulin resistance index(HOMA-IR)and insulin secretion index(HOMA-β)were calculated, and complications were recorded. Results There were no significant differences in body mass index and waist circumference between the two groups.Serum gastrin level was slightly increased in the treatment group 12 weeks after treatment, but without statistically significance 〔(127.20±9.21)ng/L vs.(131.53±7.84)ng/L, P>0.05〕, and serum gastrin level had no significant differences in the placebo group before and after treatment 〔(128.42±4.58)ng/L vs.(127.51±3.47)ng/L, P>0.05〕. However, there were no significant differences in the changes of blood glucose, HbA1c, insulin, HOMA-β and HOMA-IR before versus after therapy, and between the two group(all P>0.05). Conclusions Combined Metformin and insulin therapy cannot increase serum gastrin and insulin levels and has no significant effect on reducing blood glucose and HbA1c levels in elderly patients with type 2 diabetes. Key words: Diabetes mellitus, type 2; Proton pump inhibitor; Metformin; Gastrins; Blood glucose

Novel Use of Budesonide MMX in the Treatment of Lymphocytic Colitis

Background: Microscopic colitis, in particular, lymphocytic colitis is a relatively common cause of chronic diarrhea. The incidence of lymphocytic colitis is reported up to 63.7 per 100,000 person-years. Unfortunately, limited pharmacologic interventions are available with durable remission. We present a case of lymphocytic colitis refractory to conventional therapy with efficacy with budesonide MMX therapy. Case Presentation: A 60-year-old Caucasian retired Army service member presented to a civilian Gastroenterology clinic with complaint of chronic diarrhea. He reported having up to 6-8 liquid bowel movements per day with Bristol 5-6 consistency for over 4 months with an associated 10 pound weight loss. He was initially discontinued on esomeprazole therapy and started on loperamide with no improvement in symptoms after 4 weeks. He was started on bismuth subsalicylate for another 4 weeks with minimal to no response. He attempted a short course of oral prednisone therapy but was intolerant due to significant side effects including headaches and migraines. He underwent an EGD and repeat colonoscopy for second opinion evaluation. Random duodenal biopsies were negative for enteritis (to include celiac) and repeat colonic biopsies with persistent lymphocytic colitis but negative for infectious agents and/or inflammatory bowel disease. Patient was started on budesonide MMX therapy daily for 2 months. He noted complete resolution of symptoms with normalization of bowels within 1 week of therapy. He remained asymptomatic at follow-up 3 months after therapy completion. Discussion: Lymphocytic colitis is a common colonic disorder associated with chronic watery diarrhea. When medication side effects and food-related diarrhea is eliminated, pharmacological options are limited with short rates of durable remission. Budesonide MMX is a novel therapy option due to its formulation and colonic delivery design allowing high rates of colonic penetration with minimal systemic absorption.

Esomeprazole induced galactorrhea: a novel side effect

Proton pump inhibitors (PPIs) are one of the most frequently prescribed medications across the globe. Esomeprazole is the S-isomer of omeprazole, and it is currently the most widely prescribed PPI. The safety profile of esomeprazole is extremely favorable with only minor side effects, like headache and diarrhea, that are encountered in day to day practice. We report a case of a young female with symptoms of gastroesophageal reflux disease who developed galactorrhea after starting esomeprazole therapy. Resolution of galactorrhea after stopping the drug and self-rechallenge by the patient herself with reappearance of galactorrhea confirmed the culprit to be esomeprazole only. We postulate that esomeprazole may have a mild inhibitory effect on CYP3A4, which leads to decreased metabolism of estrogen, thereby increasing serum estrogen levels. Estrogen causes stimulation and production of prolactin release, which results in development of galactorrhea. This is the first case of esomeprazole induced galactorrhea, to the best of our knowledge.

Effects of hydrotalcite on healing quality of active gastric ulcer with Helicobacter pylori infection

Objective To observe the effects of hydrotalcite on histological ulcer healing quality in patients with Helicobacter pylori (Hp) positive active gastric ulcer. Methods A total of 145 patients with Hp positive active gastric ulcer were divided into two groups. The control group was treated with esomeprazole, amoxicillin and furazolidone triple therapy. The treatment group was treated with above triple therapy and hydrotalcite. After four-week treatment, gastroendoscopy was repeated. The sections of gastric biopsy specimens were stained with hematoxylin-eosin (HE) staining, Van Gieson staining, Alcian blue-periodic acid stiff (AB-PAS) staining, streptavidin-perosidase (SP) immunohistochemistry staining and computer imaging analysis technology were applied to observe maturity type of mucosal structure at the margin of ulcer, the content of collagen and neutral mucus, and the changes of expression of epithelial growth factor receptor (EGFR) and basic fibrobast growth factor (bFGF) before and after treatment. Paired samples t test was performed for comparison before and after treatment. F test and Chi-square test were used for comparison between two groups. Results The percentage of maturity type of regenerated mucosal structure of treatment group was 62.9% (39/62), however that of control group was 40.6% (26/64), and the difference was statistically significant (χ2=13.09, P=0.03). Compared with those before treatment, the content of collagen in granulation tissue and neutral mucus in regenerated mucosa increased in both groups after treatment, and the increase was more significant in treatment group ((55.1±10.4)% and (45.8±7.1)%, respectively); and the differences were statistically significant (F=12.85 and 18.17, both P<0.01). Compared with those before treatment, the percentage of EGFR and bFGF positive cells of both two groups increased, and the increase was more significant in treatment group ((49.5±8.4)% and (48.8±9.4)%, respectively), and the differences were statistically significant (F=12.17 and 18.73, both P<0.01). Conclusion Hydrotalcite combined with anti-Hp triple therapy can improve the maturity degree of structure and function of regenerated mucosa at the margin of ulcer in patients with Hp positive active gastric ulcer and then improve the healing quality of ulcer. Key words: Stomach ulcer; Helicobacter pylori; Healing quality of ulcer; Hydrotalcite

Turning off the Faucet: Novel Therapy for Lymphocytic Colitis

Background: Microscopic colitis, in particular, lymphocytic colitis is a relatively common cause of chronic diarrhea. The incidence of lymphocytic colitis is reported up to 63.7 per 100,000 person-years. Unfortunately, limited pharmacologic interventions are available with durable remission. We present a case of lymphocytic colitis refractory to conventional therapy with efficacy with budesonide MMX therapy. Case Presentation: A 60-year-old Caucasian retired Army service member presented to a civilian Gastroenterology clinic with complaint of chronic diarrhea. He had an associated history of GERD and hemochromatosis. He reported having up to 6-8 liquid bowel movements per day with Bristol 5-6 consistency for over 4 months. He reported having associated mild weight loss of 10 pounds. He reported no exacerbation of symptoms with lactose products and/or gluten-containing products. He underwent a colonoscopy with reports demonstrating a normal mucosal appearance but with random biopsies consistent with lymphocytic colitis. He was initially discontinued on esomeprazole therapy and started on loperamide with no improvement in symptoms after 4 weeks. He was started on bismuth subsalicylate for another 4 weeks with minimal to no response. He attempted a short course of oral prednisone therapy but was intolerant due to significant side effects including headaches and migraines. He underwent an EGD and repeat colonoscopy for second opinion evaluation. Random duodenal biopsies were negative for enteritis (to include celiac) and repeat colonic biopsies with persistent lymphocytic colitis but negative for infectious agents and/or inflammatory bowel disease (Figures 1,2). All specimens were reviewed by a gastro-pathologist.Figure 1Figure 2Patient was started on budesonide MMX therapy daily for 2 months. He noted complete resolution of symptoms with normalization of bowels within 1 week of therapy. He remained asymptomatic at followup 3 months after therapy completion. Discussion: Lymphocytic colitis is a common colonic disorder associated with chronic watery diarrhea. When medication side effects and food-related diarrhea is eliminated, pharmacological options are limited with short rates of durable remission. Budesonide MMX is a novel therapy option due to its formulation and colonic delivery design allowing high rates of colonic penetration with minimal systemic absorption.

Effect of Helicobacter pylori eradication on reflux esophagitis therapy: a multi-center randomized control study.

Background:Helicobacter pylori (H. pylori) frequently colonizes the stomach. Gastroesophageal reflux disease (GERD) is a common and costly disease. But the relationship of H. pylori and GERD is still unclear. This study aimed to explore the effect of H. pylori and its eradication on reflux esophagitis therapy.Methods:Patients diagnosed with reflux esophagitis by endoscopy were enrolled; based on rapid urease test and Warth–Starry stain, they were divided into H. pylori positive and negative groups. H. pylori positive patients were randomly given H. pylori eradication treatment for 10 days, then esomeprazole 20 mg bid for 46 days. The other patients received esomeprazole 20 mg bid therapy for 8 weeks. After treatment, three patient groups were obtained: H. pylori positive eradicated, H. pylori positive uneradicated, and H. pylori negative. Before and after therapy, reflux symptoms were scored and compared. Healing rates were compared among groups. The χ2 test and t-test were used, respectively, for enumeration and measurement data.Results:There were 176 H. pylori positive (with 92 eradication cases) and 180 negative cases. Healing rates in the H. pylori positive eradicated and H. pylori positive uneradicated groups reached 80.4% and 79.8% (P = 0.911), with reflux symptom scores of 0.22 and 0.14 (P = 0.588). Healing rates of esophagitis in the H. pylori positive uneradicated and H. pylori negative groups were, respectively, 79.8% and 82.2% (P = 0.848); reflux symptom scores were 0.14 and 0.21 (P = 0.546).Conclusions:Based on esomeprazole therapy, H. pylori infection and eradication have no significant effect on reflux esophagitis therapy.

Risk factors of incomplete response to proton pump inhibitor therapy in patients with mild erosive esophagitis

Summary Background Incomplete symptom resolution to proton pump inhibitor (PPI) therapy is a common problem in the treatment of gastroesophageal reflux disease (GERD). The aims of this study were (1) to examine the rate of incomplete symptom response following 8-week PPI therapy in patients with mild erosive esophagitis (Los Angeles Grade A/B erosive esophagitis) and (2) to determine the independent factors predicting incomplete symptom response in patients with mild erosive esophagitis. Methods From January 2010 to July 2012, symptomatic GERD patients with endoscopic findings of Los Angeles Grade A or B erosive esophagitis were recruited for the study and received esomeprazole 40 mg daily for 8 weeks. The characteristics of eligible patients including clinical factors, endoscopic findings, Helicobacter pylori status, and CYP2C19 (cytochrome P450 2C19) genotype were checked on enrollment. Patients were asked to record symptoms with diary cards during the follow-up period. The major outcome measurement was incomplete symptom response. Results In total, 232 patients (male/female, 126/106) participated in this study. Following 8-week esomeprazole therapy, 50 (21.6%) of the patients had incomplete symptom response. Univariate analysis showed that sex, alcohol consumption, underlying diseases, regurgitation of food, chest pain, globus, and insomnia were associated with incomplete symptom response ( p = 0.049, p = 0.006, p = 0.023, p = 0.010, p = 0.013, p = 0.009, and p p = 0.015] and insomnia (95% CI: 1.289–3.018; p = 0.002) were independent risk factors for incomplete symptom response with odds ratio (OR) = 2.4 and OR = 2.0, respectively. Conclusion Of the patients with Los Angeles Grade A/B erosive esophagitis, 21.6% failed to have complete symptom resolution following 8-week PPI therapy. Globus and insomnia are two independent factors predicting incomplete symptom response in patients with mild erosive esophagitis.

Eight Weeks of Esomeprazole Therapy Reduces Symptom Relapse, Compared With 4 Weeks, in Patients With Los Angeles Grade A or B Erosive Esophagitis

There is disagreement over the ideal duration of initial proton pump inhibitor (PPI) therapy for gastroesophageal reflux disease, and whether prolonged therapy increases healing of the esophagitis and prevents symptom relapse. We performed a multicenter, prospective, randomized, controlled study to compare the efficacies of 4 weeks vs 8 weeks of PPI therapy in reducing reflux symptoms and preventing symptom relapse in patients with Los Angeles grade A or B erosive esophagitis. Consecutive patients with symptomatic Los Angeles grade A or B erosive esophagitis were assigned randomly to groups given daily esomeprazole (40 mg) for 4 weeks (n = 207) or 8 weeks (n = 201) as their initial treatment. Patients with complete symptom resolution were switched to on-demand therapy until the end of week 20. All patients underwent follow-up endoscopy at the end of week 20. Symptom relapse was defined as 2 or more episodes of troublesome reflux symptoms per week or ingestion of PPI for more than 7 days within 4 weeks, owing to reflux symptoms. The 4-week and 8-week groups had comparable rates of complete symptom resolution (77.9% vs 82.1%). However, the cumulative 12-week incidence of symptom relapse was higher for the 4-week group than for the 8-week group (62.5% vs 47.8%; difference, 14.7%; 95% confidence interval, 3.7%-25.7%; P = .009). No significant difference was observed between groups in the proportions of patients with sustained healing at the end of week 20 (49.6% vs 40.9%; P = .160). Prolonging PPI therapy from 4 weeks to 8 weeks does not appear to increase the rate of complete symptom resolution in patients with mild erosive esophagitis. However, 8 weeks of PPI therapy reduces symptom relapse, compared with 4 weeks, in patients with Los Angeles grade A or B erosive esophagitis. ClinicalTrials.gov number: NCT01874535.

Effects of calcitriol on bone mineral density in patients treated with esomeprazole

Context: Proton pump inhibitor (PPI) increases the risk of decrease in bone mineral density (BMD). However, whether calcitrol improves this situation is unknown.Objective: The current study investigates the effects of calcitriol on BMD in patients with esomeprazole therapy.Materials and methods: Three hundred and eighty-six participants with gastrointestinal ulcerations were enrolled and randomly assigned into controlled and supplemented groups. Participants in the controlled group were prescribed esomeprazole (20 mg/qd), while the supplemented group was prescribed esomeprazole (20 mg/qd) and calcitriol (2.5 μg/qd). BMD, serum levels of calcium, carboxy-terminal collagen crosslinks (CTX), and alkaline-phosphatase (ALP) were assessed.Results: (1) No significant between-group difference of age, gender, smoking, previous glucocorticoid use and hemoglobin level was found; (2) after 10.6 ± 0.8 d of PPI therapy, BMD T score in the controlled group was slightly increased compared with initial (−1.25 ± 0.08 versus −1.28 ± 0.06, p = 0.084), while there was no change in the supplemented group (−1.25 ± 0.05 versus −1.26 ± 0.03, p = 0.308); (3) during study termination, calcium level in the supplemented group was slightly higher than the controlled group (2.05 ± 0.03 mmol/L versus 2.01 ± 0.05 mmol/L, p = 0.073), while no significant differences of CTX (366.57 ± 43.71 pg/mL versus 373.15 ± 50.23 pg/mL, p = 0.036) and ALP were found among these two groups (50.47 ± 9.32 U/L versus 52.23 ± 10.45 U/L, p = 0.075).Conclusion: Patients with gastrointestinal ulcerations with esomeprazole therapy, calcitriol supplement showed no efficacy on BMD changes.

APhA honors outstanding achievements at Annual Meeting

Each year, APhA recognizes exceptional contributors to the profession at the Annual Meeting. The following award winners will be honored at APhA2014 in Orlando.

Patient care services: What pharmacists do

Patient care services: What pharmacists do

Composite pH predicts esomeprazole response in laryngopharyngeal reflux without typical reflux syndrome

Factors predicting the efficacy of proton pump inhibitors (PPIs) in patients with suspected laryngopharyngeal reflux (LPR) are unclear. PPI treatment in patients without concomitant esophageal syndrome remains controversial. We investigated whether composite pH can predict PPI treatment response for LPR with or without concomitant typical reflux syndrome (CTRS). Prospective, open-label therapeutic cohort study. Patients with LPR in a tertiary center divided by presence (n = 65) and absence (n = 42) of CTRS underwent 24-hour esophagopharyngeal pH test and took esomeprazole (40 mg, twice daily) for 12 weeks. Positive composite pH was defined as the presence of 1) excessive pharyngeal acid reflux, and/or 2) excessive distal esophageal acid reflux. A responder was defined as a patient with ≥50% reduction in primary laryngeal symptoms. The change in reflux symptoms was determined using the reflux symptom index (RSI) questionnaire. Logistic regression and mixed model were used to evaluate the predictability of the composite pH parameter. After 8 and 12 weeks of treatment, participants with positive composite pH were 10.3-fold (95% confidence interval [CI], 1.7-61.5; P = .01) and 7.9-fold (95% CI, 1.4-44.8; P = .02) more likely to respond, respectively, than participants with negative composite pH among patients without CTRS. However, no difference was found in those with CTRS. Weekly repeated measures of RSI yielded similar findings. In patients with suspected LPR without CTRS, a composite pH parameter, which incorporates pharyngeal and distal esophageal acid reflux, may predict response to esomeprazole therapy.

Extremely rare case of primary esophageal mucous associated lymphoid tissue lymphoma

SJ is a 37-year-old male who presented with one year history of dysphagia, odynophagia and 15 pounds weight loss. He underwent endoscopic evaluation which showed mid esophageal ulcers. It was thought that the cause of the ulcer was the multivitamins and the patient was asked to stop them. Furthermore Esomeprazole therapy was also initiated. Patient's symptoms persisted but he did not seek any medical attention until about one year later. Meanwhile the patient reported additional 15 pounds of weight loss. We repeated upper endoscopy again which showed evidence of two chronic non bleeding irregular friable ulcerations seen in the mid esophagus, 31 cm from the incisors. Biopsies and frozen section were taken and sent for assessment to the Pathology lab. Immunoperoxidase studies on frozen sections showed the presence of IgM and for most plasma cells IgG. The microscopic and histologic findings were consistent with mucous associated lymphoid tissue lymphoma with plasmocytic differentiation. Computed tomographic scan done showed no evidence of spread to adjacent structures. The patient was referred to oncology and several cycles of radiation and Rituximab therapy were initiated which cured the disease. Subsequent endoscopies with blind biopsies were done which were negative for any neoplastic process.