Risk factors of incomplete response to proton pump inhibitor therapy in patients with mild erosive esophagitis

SummaryBackgroundIncomplete symptom resolution to proton pump inhibitor (PPI) therapy is a common problem in the treatment of gastroesophageal reflux disease (GERD). The aims of this study were (1) to examine the rate of incomplete symptom response following 8-week PPI therapy in patients with mild erosive esophagitis (Los Angeles Grade A/B erosive esophagitis) and (2) to determine the independent factors predicting incomplete symptom response in patients with mild erosive esophagitis.MethodsFrom January 2010 to July 2012, symptomatic GERD patients with endoscopic findings of Los Angeles Grade A or B erosive esophagitis were recruited for the study and received esomeprazole 40 mg daily for 8 weeks. The characteristics of eligible patients including clinical factors, endoscopic findings, Helicobacter pylori status, and CYP2C19 (cytochrome P450 2C19) genotype were checked on enrollment. Patients were asked to record symptoms with diary cards during the follow-up period. The major outcome measurement was incomplete symptom response.ResultsIn total, 232 patients (male/female, 126/106) participated in this study. Following 8-week esomeprazole therapy, 50 (21.6%) of the patients had incomplete symptom response. Univariate analysis showed that sex, alcohol consumption, underlying diseases, regurgitation of food, chest pain, globus, and insomnia were associated with incomplete symptom response (p = 0.049, p = 0.006, p = 0.023, p = 0.010, p = 0.013, p = 0.009, and p < 0.001, respectively). Multivariate analysis with stepwise logistic regression revealed that only globus [95% confidence interval (CI): 1.185–4.897; p = 0.015] and insomnia (95% CI: 1.289–3.018; p = 0.002) were independent risk factors for incomplete symptom response with odds ratio (OR) = 2.4 and OR = 2.0, respectively.ConclusionOf the patients with Los Angeles Grade A/B erosive esophagitis, 21.6% failed to have complete symptom resolution following 8-week PPI therapy. Globus and insomnia are two independent factors predicting incomplete symptom response in patients with mild erosive esophagitis.