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Esophageal mucosal breaks in GERD partially responsive to PPI therapy

This month's issue of the American Journal of Gastroenterology investigates esophageal mucosal breaks in GERD partially responsive to proton pump inhibitor 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 from North Carolina, USA determined the prevalence of esophageal mucosal breaks among patients who have a partial response to proton pump inhibitor therapy.

The research team analyzed data from a phase 2b clinical trial on the efficacy and safety of a reflux inhibitor, lesogaberan, as an add-on to proton pump inhibitor therapy in this patient population.

A total of 661 patients with persistent gastroesophageal reflux disease symptoms who had received a minimum of 4 weeks of proton pump inhibitor therapy were included in the study.

The research team assessed that prevalence of esophageal mucosal breaks was assessed according to the most recent endoscopy results from within the previous 24 months, if available, and the results of endoscopies performed at study baseline.

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

There was a prevalence of esophageal mucosal breaks of 20–30%
American Journal of Gastroenterology

The team noted that historical endoscopy results were available for 244 patients, of whom 48 had esophageal mucosal breaks.

The team of doctors assessed that baseline endoscopies were carried out in 465 patients, of whom 146 had esophageal mucosal breaks.

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

In both the historical and baseline endoscopies, most esophageal mucosal breaks were Los Angeles grades A or B.

Dr Shaheen's team concludes, "In patients with gastroesophageal reflux disease symptoms partially responsive to proton pump inhibitor therapy, mild-to-moderate severity esophageal mucosal breaks are common, and may contribute to symptom etiology."

Am J Gastroenterol 2013; 108: 529–534
10 May 2013

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