Therapy of reflux oesophagitis

Treatment of choice is the administration of PPI. Within 6-8 weeks, oesophagitis has healed in up to 90%, and more than half of the patients are free of heartburn after the first week. Though disappearance of symptoms is a valuable predictor of effective healing [8], discrepant results can be detected in up to 20%; however, in such cases residual lesions are predominantly minor in asymptomatic patients or heartburn of little intensity in healed cases.

Healing rates are influenced by the initial degree of severity with slower disappearance of peptic lesions in severe reflux oesophagitis. The EXPO study [21] including more than 3000 patients may serve as an example: after 8 weeks of pantoprazole (40 mg) therapy healing rates were 97% in mild forms (grade A according to the Los Angeles (LA) classification) gradually declining to only 74% in more severe forms (LA grade D). Nevertheless, in patients with lesions of high severity healing rates similar to those in less severe forms can be observed after more extended periods of PPI administration and/or dose escalation. Even patients with peptic strictures can be managed conservatively if PPI therapy (with even more often higher doses necessary) is combined with dilatation.

A small proportion of reflux patients will not adequately respond to standard doses of PPI, though the proportion is small in patients with uncomplicated reflux oesophagitis. In such cases, doubling the dose will lead to healing of lesions in the vast majoritiy. Failure to higher doses are rare and should question the concept that symptoms are related to oesophagitis.

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