Adequacy of acid suppression is a critical factor influencing healing in gastro-esophageal reflux disease (GERD).
The European prospective study ProGERD was set up to determine the endoscopic and symptomatic progression of GERD over 5 years under routine care, after initial acid suppression with esomeprazole.
Dr Malfertheiner and colleagues report on factors influencing endoscopic healing and symptom resolution during the acute treatment phase.
The research team obtained biopsies from the esophagus of patients with symptoms suggestive of GERD who underwent endoscopy.
The team used the information obatined from the biopsied for diagnosis of abnormalities, including Barrett’s esophagus.
| Age, sex, and body mass index appear to have no significant impact on healing|
The researchers included data from 6215 patients in the ‘intention to treat’ analysis.
The investigators reported that 3245 patients were diagnosed as having erosive reflux disease and 2970 non-erosive reflux disease.
Patient with erosive reflux disease patients were treated with esomeprazole 40 mg for 4 to 8 weeks for endoscopic healing.
The team reported that patients with non-erosive reflux disease received 20 mg esomeprazole for 2 to 4 weeks for resolution of heartburn symptoms.
The team found that endoscopic healing occurred overall in 88% of erosive reflux disease patients.
Endoscopic healing was significantly lower at 77% in those with more severe oesophagitis and at 73% in those with Barrett’s esophagus.
The researchers noted that endoscopic healing was particularly lower at 70% in Helicobacter pylori negative patients with Barrett’s esophagus.
The investigators observed that age, sex, and body mass index appeared to have no significant impact on healing.
Complete heartburn resolution was reported by 70% of erosive reflux disease patients and by 65% of non-erosive reflux disease patients at the last visit.
In addition, the team found that only H pylori infection had a significant influence on complete heartburn resolution in the non-erosive reflux disease group.
Dr Malfertheiner’s team concludes, “The presence of Barrett’s mucosa, as well as severe mucosal damage, exerts a negative impact on healing.”
“H pylori infection had a positive influence on healing in patients with erosive reflux disease and coexistent Barrett’s esophagus but no influence on those without Barrett’s esophagus.”