Predictors of either rapid healing or refractory reflux oesophagitis during
treatment with potent acid suppression.
Author(s): Kahrilas PJ(1), Persson T, Denison H, Wernersson B, Hughes N, Howden CW.
Affiliation(s): Author information:
(1)Division of Gastroenterology and Hepatology, Feinberg School of Medicine,
Northwestern University, Chicago, IL, USA.
Publication date & source: 2014, Aliment Pharmacol Ther. , 40(6):648-56
BACKGROUND: Little is known regarding patient characteristics that influence the
speed of reflux oesophagitis (RO) healing.
AIM: To investigate patient characteristics that may influence RO healing rates.
METHODS: A post hoc analysis of clinical trial data for potent acid suppression
treatment of RO (esomeprazole or AZD0865) was conducted. Group A underwent
endoscopy at baseline, week 2 and 4, and group B at baseline, week 4 and 8. Group
A patients were sub-grouped as 'rapid' (healed at 2 weeks) or unhealed at 2
weeks. Group B patients were sub-grouped as 'slow' (healed at 8 weeks, not at 4
weeks) or 'refractory' (not healed at 8 weeks). Logistic regression analysis was
performed only for comparisons within group A.
RESULTS: At 2, 4 and 8 weeks, RO had healed in 68%, 65% and 61% of patients
unhealed at previous endoscopy, respectively. Low-grade [vs. high-grade (C or D)]
RO was the only independent predictor of rapid healing in group A after logistic
regression analysis. Significantly more rapid healers had low grade RO (A or B)
at baseline than patients with refractory RO (84% vs. 49%; P < 0.001), and
significantly more refractory patients had frequent regurgitation at baseline
than slow healers (80% vs. 63%; P = 0.039).
CONCLUSIONS: Low- (vs. high-) grade RO determines the most rapid benefit from
acid suppression. Roughly two-thirds of patients healed with each time increment
of potent acid suppression therapy. This suggests that some unhealed patients may
still heal with continued therapy and that truly refractory RO is rare.
(ClinicalTrials.gov: NCT00206245).
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