Clinical features and therapeutic responses to proton pump inhibitor in patients with severe reflux esophagitis: A multicenter prospective observational study

doi:10.1002/jgh3.12455

. 2020 Dec 8;5(1):99-106.

doi: 10.1002/jgh3.12455. eCollection 2021 Jan.

Clinical features and therapeutic responses to proton pump inhibitor in patients with severe reflux esophagitis: A multicenter prospective observational study

Kimio Isshi^{1

2}, Nobuyuki Matsuhashi³, Takashi Joh⁴, Kazuhide Higuchi⁵, Katsuhiko Iwakiri⁶, Takeshi Kamiya⁷, Noriaki Manabe⁸, Tatsuya Nakada⁹, Maiko Ogawa⁹, Seiji Arihiro⁹, Ken Haruma¹⁰, Koji Nakada¹¹

Affiliations

¹ Department of Gastroenterology Isshi Gastro-Intestinal Clinic 2-15-21, Shinozaki-cho Edogawa-Ku 133-0061 Tokyo Japan.
² Department of Endoscopy The Jikei University School of Medicine 3-15-8, Nishishinbashi Minato-Ku 105-8461 Tokyo Japan.
³ Department of Gastroenterology NTT Medical Center Tokyo 5-9-22, Higashi-Gotanda Shinagawa-Ku 144-8625 Tokyo Japan.
⁴ Department of Gastroenterology Gamagori City Hospital 1-1, Mukaida Hirata-cho Gamagori 443-8501 Aichi Japan.
⁵ Second Department of Internal Medicine Osaka Medical College 2-7, Daigakumachi Takatsuki 569-8686 Osaka Japan.
⁶ Department of Gastroenterology Nippon Medical School Graduate School of Medicine 1-1-5, Sendagi Bunkyo-Ku 133-8603 Tokyo Japan.
⁷ Department of Medical Innovation Nagoya City University Graduate School Medical Sciences 1, Kwasumi Mizuhocho, Mizuho-Ku Nagoya 467-8601 Aichi Japan.
⁸ Division of Endoscopy and Ultrasonography, Department of Laboratory Medicine Kawasaki Medical School 2-6-1, Nakasange, Kita-Ku Okayama 700-8505 Okayama Japan.
⁹ Division of Gastroenterology and Hepatology, Department of Internal Medicine Katsushika Medical Center, The Jikei University School of Medicine 6-41-2, Aoto Katsushika-Ku 125-8506 Tokyo Japan.
¹⁰ Department of General Internal Medicine 2 Kawasaki Medical School Kawasaki Hospital 577, Matsushima Kurashiki 701-0192 Okayama Japan.
¹¹ Department of Laboratory Medicine The Jikei University School of Medicine 3-25-8, Nishishinbashi Minato-Ku 105-8461 Tokyo Japan.

PMID: 33490619
PMCID: PMC7812480
DOI: 10.1002/jgh3.12455

Clinical features and therapeutic responses to proton pump inhibitor in patients with severe reflux esophagitis: A multicenter prospective observational study

Kimio Isshi et al. JGH Open. 2020.

. 2020 Dec 8;5(1):99-106.

doi: 10.1002/jgh3.12455. eCollection 2021 Jan.

Authors

Affiliations

¹ Department of Gastroenterology Isshi Gastro-Intestinal Clinic 2-15-21, Shinozaki-cho Edogawa-Ku 133-0061 Tokyo Japan.
² Department of Endoscopy The Jikei University School of Medicine 3-15-8, Nishishinbashi Minato-Ku 105-8461 Tokyo Japan.
³ Department of Gastroenterology NTT Medical Center Tokyo 5-9-22, Higashi-Gotanda Shinagawa-Ku 144-8625 Tokyo Japan.
⁴ Department of Gastroenterology Gamagori City Hospital 1-1, Mukaida Hirata-cho Gamagori 443-8501 Aichi Japan.
⁵ Second Department of Internal Medicine Osaka Medical College 2-7, Daigakumachi Takatsuki 569-8686 Osaka Japan.
⁶ Department of Gastroenterology Nippon Medical School Graduate School of Medicine 1-1-5, Sendagi Bunkyo-Ku 133-8603 Tokyo Japan.
⁷ Department of Medical Innovation Nagoya City University Graduate School Medical Sciences 1, Kwasumi Mizuhocho, Mizuho-Ku Nagoya 467-8601 Aichi Japan.
⁸ Division of Endoscopy and Ultrasonography, Department of Laboratory Medicine Kawasaki Medical School 2-6-1, Nakasange, Kita-Ku Okayama 700-8505 Okayama Japan.
⁹ Division of Gastroenterology and Hepatology, Department of Internal Medicine Katsushika Medical Center, The Jikei University School of Medicine 6-41-2, Aoto Katsushika-Ku 125-8506 Tokyo Japan.
¹⁰ Department of General Internal Medicine 2 Kawasaki Medical School Kawasaki Hospital 577, Matsushima Kurashiki 701-0192 Okayama Japan.
¹¹ Department of Laboratory Medicine The Jikei University School of Medicine 3-25-8, Nishishinbashi Minato-Ku 105-8461 Tokyo Japan.

PMID: 33490619
PMCID: PMC7812480
DOI: 10.1002/jgh3.12455

Abstract

Background and aim: In patients with severe erosive reflux disease (ERD; Los Angeles classification grade C/D) who do not undergo endoscopic examination, insufficient strength and duration of proton pump inhibitor (PPI) therapy may lead to complications such as esophageal bleeding and stenosis. Therefore, to provide a safe and effective treatment for gastroesophageal reflux disease (GERD), we investigated the clinical features of patients with severe ERD and their responses to PPI therapy.

Methods: Patients with GERD symptoms received PPI therapy for 4 weeks after endoscopic examination. The patients completed the Gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test questionnaire before and 2 or 4 weeks after PPI treatment. Patient characteristics, presence/absence of coexisting atrophic gastritis (AG) and hiatus hernia (HH), and responses to PPI therapy were compared in patients with GERD among three groups (nonerosive reflux disease, mild ERD [grade A/B], and severe ERD).

Results: The severe ERD group had a significantly higher proportion of males, higher body mass index, and longer duration of GERD morbidity. Furthermore, the severe ERD group also had a significantly lower incidence of coexisting AG and higher incidence of HH. There was no difference in the severity of GERD before PPI treatment among the three groups. Unexpectedly, the response to PPI therapy was the best in the severe ERD group.

Conclusion: Sufficient strength and period of PPI therapy are required, even if the symptoms show early improvement, when treating GERD patients without performing endoscopy, considering the possibility of severe ERD.

Keywords: complications; gastroesophageal reflux disease; modified Los Angeles classification; proton pump inhibitor; severe erosive reflux disease; therapeutic response.

PubMed Disclaimer

Figures

**Figure 1**
Flowchart of patient enrollment and data analysis. GERD‐TEST, gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test

See this image and copyright information in PMC

Cited by

Monitoring of serum magnesium levels during long-term use of proton pump inhibitors in elderly japanese patients: is it really necessary or not?
Nakamura N, Yoneda K, Higo T, Kusumoto M. Nakamura N, et al. J Pharm Health Care Sci. 2022 Dec 14;8(1):35. doi: 10.1186/s40780-022-00266-7. J Pharm Health Care Sci. 2022. PMID: 36514145 Free PMC article.
Drug treatment strategies for erosive esophagitis in adults: a narrative review.
Shibli F, Mari A, Fass R. Shibli F, et al. Transl Gastroenterol Hepatol. 2025 Jul 23;10:54. doi: 10.21037/tgh-24-168. eCollection 2025. Transl Gastroenterol Hepatol. 2025. PMID: 40755734 Free PMC article. Review.

References

1. Iwakiri K, Kinoshita Y, Habu Y et al Evidence‐based clinical practice guidelines for gastroesophageal reflux disease 2015. J. Gastoroenterol. 2016; 51: 751–67. - PubMed
1. Lundell LR, Dent J, Bennett JR et al Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999; 45: 172–80. - PMC - PubMed
1. Hongo M. Minimal changes in reflux esophagitis: red ones and white ones. J. Gastroenterol. 2006; 41: 95–9. - PubMed
1. Yamaguchi M, Iwakiri R, Yamaguchi K et al Bleeding and stenosis caused by reflux esophagitis was not common in emergency endoscopic examinations: a retrospective patient chart review at a single institution in Japan. J. Gastroenterol. 2008; 43: 265–59. - PubMed
1. Sakaguchi M, Manabe N, Ueki N et al Factors associated with complicated erosive esophagitis: a Japanese multicenter, prospective, cross‐sectional study. World J. Gastroenterol. 2017; 23: 318–27. - PMC - PubMed

LinkOut - more resources

Full Text Sources

[1] Iwakiri K, Kinoshita Y, Habu Y et al Evidence‐based clinical practice guidelines for gastroesophageal reflux disease 2015. J. Gastoroenterol. 2016; 51: 751–67. - PubMed

[2] Iwakiri K, Kinoshita Y, Habu Y et al Evidence‐based clinical practice guidelines for gastroesophageal reflux disease 2015. J. Gastoroenterol. 2016; 51: 751–67. - PubMed

[3] Lundell LR, Dent J, Bennett JR et al Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999; 45: 172–80. - PMC - PubMed

[4] Lundell LR, Dent J, Bennett JR et al Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999; 45: 172–80. - PMC - PubMed

[5] Hongo M. Minimal changes in reflux esophagitis: red ones and white ones. J. Gastroenterol. 2006; 41: 95–9. - PubMed

[6] Hongo M. Minimal changes in reflux esophagitis: red ones and white ones. J. Gastroenterol. 2006; 41: 95–9. - PubMed

[7] Yamaguchi M, Iwakiri R, Yamaguchi K et al Bleeding and stenosis caused by reflux esophagitis was not common in emergency endoscopic examinations: a retrospective patient chart review at a single institution in Japan. J. Gastroenterol. 2008; 43: 265–59. - PubMed

[8] Yamaguchi M, Iwakiri R, Yamaguchi K et al Bleeding and stenosis caused by reflux esophagitis was not common in emergency endoscopic examinations: a retrospective patient chart review at a single institution in Japan. J. Gastroenterol. 2008; 43: 265–59. - PubMed

[9] Sakaguchi M, Manabe N, Ueki N et al Factors associated with complicated erosive esophagitis: a Japanese multicenter, prospective, cross‐sectional study. World J. Gastroenterol. 2017; 23: 318–27. - PMC - PubMed

[10] Sakaguchi M, Manabe N, Ueki N et al Factors associated with complicated erosive esophagitis: a Japanese multicenter, prospective, cross‐sectional study. World J. Gastroenterol. 2017; 23: 318–27. - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Clinical features and therapeutic responses to proton pump inhibitor in patients with severe reflux esophagitis: A multicenter prospective observational study

Affiliations

Clinical features and therapeutic responses to proton pump inhibitor in patients with severe reflux esophagitis: A multicenter prospective observational study

Authors

Affiliations

Abstract

Figures

Similar articles

Cited by

References

LinkOut - more resources

Full Text Sources

Abstract

Figures

Similar articles

Cited by

References

Related information

LinkOut - more resources

Full Text Sources