Erosive Esophagitis Portends a Benign Clinical Course in the Majority of Patients
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ORIGINAL ARTICLE
Erosive Esophagitis Portends a Benign Clinical Course in the Majority of Patients Danse Bi1 · David A. Katzka1 · Crystal J. Lavey1 · Debra M. Geno1 · Karthik Ravi1 Received: 27 June 2019 / Accepted: 22 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Indefinite proton pump inhibitor (PPI) therapy and endoscopic evaluation for Barrett’s esophagus is recommended for erosive esophagitis (EE). However, the clinical course of EE remains undefined. Methods Adults with EE on esophagogastroduodenoscopy (EGD) were identified at Mayo Clinic Rochester between January 2003 and September 2005. Patients with repeat EGD performed after index endoscopy were included. Patients with a history of upper gastrointestinal surgery, esophageal cancer, achalasia, or Barrett’s on initial EGD were excluded. Results Of 219 patients identified, 98 had LA grade A, 72 LA grade B, and 49 LA grade C esophagitis. Persistent EE was found in 27% on repeat endoscopy. No patients progressed to more severe grades of esophagitis. While discontinuation of PPI was associated with persistent esophagitis, long-term healing of esophagitis occurred in the majority of patients despite discontinuation of PPI. Grade A or B esophagitis and the absence of hiatal hernia were also independent predictors of esophagitis healing on multivariate analysis. The rate of Barrett’s esophagus was similar among patients with LA grade A/B and C esophagitis on initial EGD (5% vs. 14%, p = 0.6). Conclusion The majority of patients with EE demonstrated healing at follow-up endoscopy regardless of continued PPI use. A small proportion developed Barrett’s esophagus, including those with LA grade A and B esophagitis, highlighting a potential role for repeat endoscopy in all grades of EE. A more conservative long-term PPI strategy may be reasonable in patients with LA grade A or B esophagitis in the absence of hiatal hernia. Keywords Erosive esophagitis · Barrett’s esophagus · GERD · LA grade
Introduction Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases in the USA [1]. Approximately 30% of patients with GERD will develop erosive esophagitis (EE) as a complication [2–4]. The severity of erosive esophagitis is graded by the Los Angeles (LA) classification system with more severe esophagitis progressively from grade A to D. In general, patients with erosive esophagitis are thought to have more Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10620-019-06027-1) contains supplementary material, which is available to authorized users. * Karthik Ravi [email protected] 1
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
persistent symptoms and to be at higher risk of gastroesophageal reflux related complications compared to those with non-erosive reflux disease [5, 6]. However, while a common dictum holds that erosive esophagitis requires indefinite acid suppre
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