Erosive Esophagitis Portends a Benign Clinical Course in the Majority of Patients.
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.
['Bi|Danse|D|', 'Katzka|David A|DA|', 'Lavey|Crystal J|CJ|', 'Geno|Debra M|DM|', 'Ravi|Karthik|K|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D001471:Barrett Esophagus D018450:Disease Progression D004941:Esophagitis D004945:Esophagoscopy D005764:Gastroesophageal Reflux D006801:Humans D008297:Male D008875:Middle Aged D011379:Prognosis D054328:Proton Pump Inhibitors D012189:Retrospective Studies
Erosive esophagitis LA grade Barrett’s esophagus GERD