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Erosive Esophagitis Portends a Benign Clinical Course in the Majority of Patients

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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.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA

    Danse Bi, David A. Katzka, Crystal J. Lavey, Debra M. Geno & Karthik Ravi

Authors
  1. Danse Bi
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  2. David A. Katzka
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  3. Crystal J. Lavey
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  4. Debra M. Geno
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  5. Karthik Ravi
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Contributions

Dr. Bi (Bi.Danse@mayo.edu) is a resident in the department of Internal Medicine at the Mayo Clinic Rochester. She was instrumental in the collection and analysis of the data and writing of the manuscript. Dr. Katzka (Katzka.David@mayo.edu) is a gastroenterologist in the department of Gastroenterology and Hepatology at the Mayo Clinic Rochester. He assisted in the conduct of the study and drafting of the manuscript. Crystal Lavey (Lavey.Crystal@mayo.edu) is a research assistant in the department of Gastroenterology and Hepatology at the Mayo Clinic Rochester. She assisted in the collection of the data. Dr. Ravi (Ravi.Karthik@mayo.edu) is a gastroenterologist in the department of Gastroenterology and Hepatology at the Mayo Clinic Rochester. He was instrumental in the design and conduct of the study, the collection and analysis of the data, and writing of the manuscript. None of the authors has any financial disclosures and all approve the final manuscript for submission.

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Correspondence to Karthik Ravi.

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Bi, D., Katzka, D.A., Lavey, C.J. et al. Erosive Esophagitis Portends a Benign Clinical Course in the Majority of Patients. Dig Dis Sci 65, 3244–3252 (2020). https://doi.org/10.1007/s10620-019-06027-1

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  • DOI: https://doi.org/10.1007/s10620-019-06027-1

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