Clinical features and therapeutic responses to proton pump inhibitor in patients with severe reflux esophagitis: A multicenter prospective observational study
Kimio Isshi,
Nobuyuki Matsuhashi,
Takashi Joh,
Kazuhide Higuchi,
Katsuhiko Iwakiri,
Takeshi Kamiya,
Noriaki Manabe,
Tatsuya Nakada,
Maiko Ogawa,
Seiji Arihiro,
Ken Haruma,
Koji Nakada
Affiliations
Kimio Isshi
Department of Gastroenterology Isshi Gastro‐Intestinal Clinic 2‐15‐21, Shinozaki‐cho Edogawa‐Ku 133‐0061 Tokyo Japan
Nobuyuki Matsuhashi
Department of Gastroenterology NTT Medical Center Tokyo 5‐9‐22, Higashi‐Gotanda Shinagawa‐Ku 144‐8625 Tokyo Japan
Takashi Joh
Department of Gastroenterology Gamagori City Hospital 1‐1, Mukaida Hirata‐cho Gamagori 443‐8501 Aichi Japan
Kazuhide Higuchi
Second Department of Internal Medicine Osaka Medical College 2‐7, Daigakumachi Takatsuki 569‐8686 Osaka Japan
Katsuhiko Iwakiri
Department of Gastroenterology Nippon Medical School Graduate School of Medicine 1‐1‐5, Sendagi Bunkyo‐Ku 133‐8603 Tokyo Japan
Takeshi Kamiya
Department of Medical Innovation Nagoya City University Graduate School Medical Sciences 1, Kwasumi Mizuhocho, Mizuho‐Ku Nagoya 467‐8601 Aichi Japan
Noriaki Manabe
Division of Endoscopy and Ultrasonography, Department of Laboratory Medicine Kawasaki Medical School 2‐6‐1, Nakasange, Kita‐Ku Okayama 700‐8505 Okayama Japan
Tatsuya Nakada
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
Maiko Ogawa
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
Seiji Arihiro
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
Ken Haruma
Department of General Internal Medicine 2 Kawasaki Medical School Kawasaki Hospital 577, Matsushima Kurashiki 701‐0192 Okayama Japan
Koji Nakada
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.
