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Esophageal mucosal breaks in GERD partially responsive to PPI therapy

April's issue of the American Journal of Gastroenterology examines esophageal mucosal breaks in GERD partially responsive to PPI therapy.

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Approximately 20–30% of patients with gastroesophageal reflux disease (GERD) do not experience complete symptom resolution during proton pump inhibitor (PPI) therapy.

Dr Nicholas Shaheen and colleagues determined the prevalence of esophageal mucosal breaks among patients who have a partial response to PPI therapy.

The researchers performed an analysis of data from a phase 2b clinical trial carried out to assess the efficacy and safety of a reflux inhibitor, lesogaberan (AZD3355), as an add-on to PPI therapy in this patient population.

A total of 661 patients with persistent GERD symptoms who had received a minimum of 4 weeks of PPI therapy were included in the study.

Prevalence of esophageal mucosal breaks was 20–30%
American Journal of Gastroenterology

The prevalence of esophageal mucosal breaks was assessed according to the most recent endoscopy results from within the previous 24 months, if available.

In addition, the prevalence of esophageal mucosal breaks was assessed according to the results of endoscopies performed at study baseline (“baseline” endoscopies).

Baseline endoscopies were not carried out in patients who had a historical endoscopy showing an absence of esophageal mucosal breaks.

Historical endoscopy results were available for 244 patients, of whom 20% had esophageal mucosal breaks.

The team carried out baseline endoscopies were carried out in 465 patients, of whom 31% had esophageal mucosal breaks.

Sensitivity analyses showed a prevalence of esophageal mucosal breaks of 20–30%.

The researchers observed that in both the historical and baseline endoscopies, most esophageal mucosal breaks were Los Angeles grades A or B.

Dr Shaheen's team conclude, "In patients with GERD symptoms partially responsive to PPI therapy, mild-to-moderate severity esophageal mucosal breaks are common, and may contribute to symptom etiology."

Am J Gastroenterol 2013; 108:529–534
22 April 2013

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