Short and long-term outcome of medically treated reflux esophagitis

The purpose of this retrospective study was to characterize the clinical course of medically-treated reflux esophagitis and to identify factors related to acute healing and relapse of the disease. We investigated 77 patients (56 males, 21 females, mean age 46.9 years) suffering from esophagitis (grade I-IV according to Savary and Miller), who were referred to our Unit during the period between January 1984 and December 1988. Typical GER symptoms were present in 63 patients, 51 of whom had esophageal 24-hour pH-monitoring suggestive of pathological GER, defined as total time with pH < 4 equal to or greater than 7%. All patients received 3 to 6 months of treatment (H2-antagonists = 68, antacids = 6, prokinetic drugs = 1, omeprazole = 2). After 3 months of therapy 39/88 patients (50.7%) had healed, and this figure increased to 56/77 patients (72.7%) after 6 months. The majority of these patients (N = 49) subsequently underwent a 24-week course of treatment, mostly with low-dose H2-antagonists (N = 44). At the end of treatment, 34/49 patients (69.3%) remained healed, while 15/49 (30.7%) relapsed, 40% asymptomatically. 14/21 patients (66.7%) who were not healed after 6 months' therapy, healed when the same treatment was prolonged up to 18 months (median: 11 months). The only factor found to influence acute healing significantly was the type of therapy, while none of the variables analyzed were seen to correlate with disease relapse.