Eight weeks of esomeprazole therapy reduces symptom relapse, compared with 4 weeks, in patients with los angeles grade a or b erosive esophagitis

Ping I. Hsu, Ching Liang Lu, Deng Chyang Wu, Chao Hung Kuo, Sung Shuo Kao, Chun Chao Chang, Wei Chen Tai, Kwok Hung Lai, Wen Chih Chen, Huay Min Wang, Jin Shiung Cheng, Tzung Jiun Tsai, Seng Kee Chuah

研究成果: 雜誌貢獻文章

12 引文 (Scopus)

摘要

Background & Aims: There is disagreement over the ideal duration of initial proton pump inhibitor (PPI) therapy for gastroesophageal reflux disease, and whether prolonged therapy increases healing of the esophagitis and prevents symptom relapse. We performed a multicenter, prospective, randomized, controlled study to compare the efficacies of 4 weeks vs 8 weeks of PPI therapy in reducing reflux symptoms and preventing symptom relapse in patients with Los Angeles grade A or B erosive esophagitis. Methods: Consecutive patients with symptomatic Los Angeles grade A or B erosive esophagitis were assigned randomly to groups given daily esomeprazole (40 mg) for 4 weeks (n= 207) or 8 weeks (n= 201) as their initial treatment. Patients with complete symptom resolution were switched to on-demand therapy until the end of week 20. All patients underwent follow-up endoscopy at the end of week 20. Symptom relapse was defined as 2 or more episodes of troublesome reflux symptoms per week or ingestion of PPI for more than 7 days within 4weeks, owing to reflux symptoms. Results: The 4-week and 8-week groups had comparable rates of complete symptom resolution (77.9% vs 82.1%). However, the cumulative 12-week incidence of symptom relapse was higher for the 4-week group than for the 8-week group (62.5% vs 47.8%; difference, 14.7%; 95% confidence interval, 3.7%-25.7%; P= .009). No significant difference was observed between groups in the proportions of patients with sustained healing at the end of week 20 (49.6% vs 40.9%; P= .160). Conclusions: Prolonging PPI therapy from 4 weeks to 8 weeks does not appear to increase the rate of complete symptom resolution in patients with mild erosive esophagitis. However, 8 weeks of PPI therapy reduces symptom relapse, compared with 4 weeks, in patients with Los Angeles grade A or B erosive esophagitis. ClinicalTrials.gov number: NCT01874535.

原文英語
頁(從 - 到)859-866
頁數8
期刊Clinical Gastroenterology and Hepatology
13
發行號5
DOIs
出版狀態已發佈 - 五月 1 2015

指紋

Esomeprazole
Los Angeles
Esophagitis
Proton Pump Inhibitors
Recurrence
Therapeutics
Gastroesophageal Reflux
Endoscopy
Eating
Confidence Intervals
Incidence

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

引用此文

Eight weeks of esomeprazole therapy reduces symptom relapse, compared with 4 weeks, in patients with los angeles grade a or b erosive esophagitis. / Hsu, Ping I.; Lu, Ching Liang; Wu, Deng Chyang; Kuo, Chao Hung; Kao, Sung Shuo; Chang, Chun Chao; Tai, Wei Chen; Lai, Kwok Hung; Chen, Wen Chih; Wang, Huay Min; Cheng, Jin Shiung; Tsai, Tzung Jiun; Chuah, Seng Kee.

於: Clinical Gastroenterology and Hepatology, 卷 13, 編號 5, 01.05.2015, p. 859-866.

研究成果: 雜誌貢獻文章

Hsu, Ping I. ; Lu, Ching Liang ; Wu, Deng Chyang ; Kuo, Chao Hung ; Kao, Sung Shuo ; Chang, Chun Chao ; Tai, Wei Chen ; Lai, Kwok Hung ; Chen, Wen Chih ; Wang, Huay Min ; Cheng, Jin Shiung ; Tsai, Tzung Jiun ; Chuah, Seng Kee. / Eight weeks of esomeprazole therapy reduces symptom relapse, compared with 4 weeks, in patients with los angeles grade a or b erosive esophagitis. 於: Clinical Gastroenterology and Hepatology. 2015 ; 卷 13, 編號 5. 頁 859-866.
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abstract = "Background & Aims: There is disagreement over the ideal duration of initial proton pump inhibitor (PPI) therapy for gastroesophageal reflux disease, and whether prolonged therapy increases healing of the esophagitis and prevents symptom relapse. We performed a multicenter, prospective, randomized, controlled study to compare the efficacies of 4 weeks vs 8 weeks of PPI therapy in reducing reflux symptoms and preventing symptom relapse in patients with Los Angeles grade A or B erosive esophagitis. Methods: Consecutive patients with symptomatic Los Angeles grade A or B erosive esophagitis were assigned randomly to groups given daily esomeprazole (40 mg) for 4 weeks (n= 207) or 8 weeks (n= 201) as their initial treatment. Patients with complete symptom resolution were switched to on-demand therapy until the end of week 20. All patients underwent follow-up endoscopy at the end of week 20. Symptom relapse was defined as 2 or more episodes of troublesome reflux symptoms per week or ingestion of PPI for more than 7 days within 4weeks, owing to reflux symptoms. Results: The 4-week and 8-week groups had comparable rates of complete symptom resolution (77.9{\%} vs 82.1{\%}). However, the cumulative 12-week incidence of symptom relapse was higher for the 4-week group than for the 8-week group (62.5{\%} vs 47.8{\%}; difference, 14.7{\%}; 95{\%} confidence interval, 3.7{\%}-25.7{\%}; P= .009). No significant difference was observed between groups in the proportions of patients with sustained healing at the end of week 20 (49.6{\%} vs 40.9{\%}; P= .160). Conclusions: Prolonging PPI therapy from 4 weeks to 8 weeks does not appear to increase the rate of complete symptom resolution in patients with mild erosive esophagitis. However, 8 weeks of PPI therapy reduces symptom relapse, compared with 4 weeks, in patients with Los Angeles grade A or B erosive esophagitis. ClinicalTrials.gov number: NCT01874535.",
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AU - Hsu, Ping I.

AU - Lu, Ching Liang

AU - Wu, Deng Chyang

AU - Kuo, Chao Hung

AU - Kao, Sung Shuo

AU - Chang, Chun Chao

AU - Tai, Wei Chen

AU - Lai, Kwok Hung

AU - Chen, Wen Chih

AU - Wang, Huay Min

AU - Cheng, Jin Shiung

AU - Tsai, Tzung Jiun

AU - Chuah, Seng Kee

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N2 - Background & Aims: There is disagreement over the ideal duration of initial proton pump inhibitor (PPI) therapy for gastroesophageal reflux disease, and whether prolonged therapy increases healing of the esophagitis and prevents symptom relapse. We performed a multicenter, prospective, randomized, controlled study to compare the efficacies of 4 weeks vs 8 weeks of PPI therapy in reducing reflux symptoms and preventing symptom relapse in patients with Los Angeles grade A or B erosive esophagitis. Methods: Consecutive patients with symptomatic Los Angeles grade A or B erosive esophagitis were assigned randomly to groups given daily esomeprazole (40 mg) for 4 weeks (n= 207) or 8 weeks (n= 201) as their initial treatment. Patients with complete symptom resolution were switched to on-demand therapy until the end of week 20. All patients underwent follow-up endoscopy at the end of week 20. Symptom relapse was defined as 2 or more episodes of troublesome reflux symptoms per week or ingestion of PPI for more than 7 days within 4weeks, owing to reflux symptoms. Results: The 4-week and 8-week groups had comparable rates of complete symptom resolution (77.9% vs 82.1%). However, the cumulative 12-week incidence of symptom relapse was higher for the 4-week group than for the 8-week group (62.5% vs 47.8%; difference, 14.7%; 95% confidence interval, 3.7%-25.7%; P= .009). No significant difference was observed between groups in the proportions of patients with sustained healing at the end of week 20 (49.6% vs 40.9%; P= .160). Conclusions: Prolonging PPI therapy from 4 weeks to 8 weeks does not appear to increase the rate of complete symptom resolution in patients with mild erosive esophagitis. However, 8 weeks of PPI therapy reduces symptom relapse, compared with 4 weeks, in patients with Los Angeles grade A or B erosive esophagitis. ClinicalTrials.gov number: NCT01874535.

AB - Background & Aims: There is disagreement over the ideal duration of initial proton pump inhibitor (PPI) therapy for gastroesophageal reflux disease, and whether prolonged therapy increases healing of the esophagitis and prevents symptom relapse. We performed a multicenter, prospective, randomized, controlled study to compare the efficacies of 4 weeks vs 8 weeks of PPI therapy in reducing reflux symptoms and preventing symptom relapse in patients with Los Angeles grade A or B erosive esophagitis. Methods: Consecutive patients with symptomatic Los Angeles grade A or B erosive esophagitis were assigned randomly to groups given daily esomeprazole (40 mg) for 4 weeks (n= 207) or 8 weeks (n= 201) as their initial treatment. Patients with complete symptom resolution were switched to on-demand therapy until the end of week 20. All patients underwent follow-up endoscopy at the end of week 20. Symptom relapse was defined as 2 or more episodes of troublesome reflux symptoms per week or ingestion of PPI for more than 7 days within 4weeks, owing to reflux symptoms. Results: The 4-week and 8-week groups had comparable rates of complete symptom resolution (77.9% vs 82.1%). However, the cumulative 12-week incidence of symptom relapse was higher for the 4-week group than for the 8-week group (62.5% vs 47.8%; difference, 14.7%; 95% confidence interval, 3.7%-25.7%; P= .009). No significant difference was observed between groups in the proportions of patients with sustained healing at the end of week 20 (49.6% vs 40.9%; P= .160). Conclusions: Prolonging PPI therapy from 4 weeks to 8 weeks does not appear to increase the rate of complete symptom resolution in patients with mild erosive esophagitis. However, 8 weeks of PPI therapy reduces symptom relapse, compared with 4 weeks, in patients with Los Angeles grade A or B erosive esophagitis. ClinicalTrials.gov number: NCT01874535.

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KW - Comparative trial

KW - Esophagus

KW - GERD

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