Kimio Isshi1,2, Nobuyuki Matsuhashi3, Takashi Joh4, Kazuhide Higuchi5, Katsuhiko Iwakiri6, Takeshi Kamiya7, Noriaki Manabe8, Tatsuya Nakada9, Maiko Ogawa9, Seiji Arihiro9, Ken Haruma10, Koji Nakada11. 1. Department of Gastroenterology Isshi Gastro-Intestinal Clinic 2-15-21, Shinozaki-cho Edogawa-Ku 133-0061 Tokyo Japan. 2. Department of Endoscopy The Jikei University School of Medicine 3-15-8, Nishishinbashi Minato-Ku 105-8461 Tokyo Japan. 3. Department of Gastroenterology NTT Medical Center Tokyo 5-9-22, Higashi-Gotanda Shinagawa-Ku 144-8625 Tokyo Japan. 4. Department of Gastroenterology Gamagori City Hospital 1-1, Mukaida Hirata-cho Gamagori 443-8501 Aichi Japan. 5. Second Department of Internal Medicine Osaka Medical College 2-7, Daigakumachi Takatsuki 569-8686 Osaka Japan. 6. Department of Gastroenterology Nippon Medical School Graduate School of Medicine 1-1-5, Sendagi Bunkyo-Ku 133-8603 Tokyo Japan. 7. Department of Medical Innovation Nagoya City University Graduate School Medical Sciences 1, Kwasumi Mizuhocho, Mizuho-Ku Nagoya 467-8601 Aichi Japan. 8. Division of Endoscopy and Ultrasonography, Department of Laboratory Medicine Kawasaki Medical School 2-6-1, Nakasange, Kita-Ku Okayama 700-8505 Okayama Japan. 9. Division of Gastroenterology and Hepatology, Department of Internal Medicine Katsushika Medical Center, The Jikei University School of Medicine 6-41-2, Aoto Katsushika-Ku 125-8506 Tokyo Japan. 10. Department of General Internal Medicine 2 Kawasaki Medical School Kawasaki Hospital 577, Matsushima Kurashiki 701-0192 Okayama Japan. 11. Department of Laboratory Medicine The Jikei University School of Medicine 3-25-8, Nishishinbashi Minato-Ku 105-8461 Tokyo Japan.
Abstract
BACKGROUND AND AIM: In patients with severe erosive reflux disease (ERD; Los Angeles classification grade C/D) who do not undergo endoscopic examination, insufficient strength and duration of proton pump inhibitor (PPI) therapy may lead to complications such as esophageal bleeding and stenosis. Therefore, to provide a safe and effective treatment for gastroesophageal reflux disease (GERD), we investigated the clinical features of patients with severe ERD and their responses to PPI therapy. METHODS: Patients with GERD symptoms received PPI therapy for 4 weeks after endoscopic examination. The patients completed the Gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test questionnaire before and 2 or 4 weeks after PPI treatment. Patient characteristics, presence/absence of coexisting atrophic gastritis (AG) and hiatus hernia (HH), and responses to PPI therapy were compared in patients with GERD among three groups (nonerosive reflux disease, mild ERD [grade A/B], and severe ERD). RESULTS: The severe ERD group had a significantly higher proportion of males, higher body mass index, and longer duration of GERD morbidity. Furthermore, the severe ERD group also had a significantly lower incidence of coexisting AG and higher incidence of HH. There was no difference in the severity of GERD before PPI treatment among the three groups. Unexpectedly, the response to PPI therapy was the best in the severe ERD group. CONCLUSION: Sufficient strength and period of PPI therapy are required, even if the symptoms show early improvement, when treating GERD patients without performing endoscopy, considering the possibility of severe ERD.
BACKGROUND AND AIM: In patients with severe erosive reflux disease (ERD; Los Angeles classification grade C/D) who do not undergo endoscopic examination, insufficient strength and duration of proton pump inhibitor (PPI) therapy may lead to complications such as esophageal bleeding and stenosis. Therefore, to provide a safe and effective treatment for gastroesophageal reflux disease (GERD), we investigated the clinical features of patients with severe ERD and their responses to PPI therapy. METHODS: Patients with GERD symptoms received PPI therapy for 4 weeks after endoscopic examination. The patients completed the Gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test questionnaire before and 2 or 4 weeks after PPI treatment. Patient characteristics, presence/absence of coexisting atrophic gastritis (AG) and hiatus hernia (HH), and responses to PPI therapy were compared in patients with GERD among three groups (nonerosive reflux disease, mild ERD [grade A/B], and severe ERD). RESULTS: The severe ERD group had a significantly higher proportion of males, higher body mass index, and longer duration of GERD morbidity. Furthermore, the severe ERD group also had a significantly lower incidence of coexisting AG and higher incidence of HH. There was no difference in the severity of GERD before PPI treatment among the three groups. Unexpectedly, the response to PPI therapy was the best in the severe ERD group. CONCLUSION: Sufficient strength and period of PPI therapy are required, even if the symptoms show early improvement, when treating GERD patients without performing endoscopy, considering the possibility of severe ERD.