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Esophageal Mucosal Breaks in Gastroesophageal Reflux Disease Partially Responsive to Proton Pump Inhibitor Therapy

Shaheen, Nicholas J MD, MPH1; Denison, Hans MD2; Björck, Karin MSc2; Silberg, Debra G MD, PhD3

American Journal of Gastroenterology: April 2013 - Volume 108 - Issue 4 - p 529–534
doi: 10.1038/ajg.2012.447

OBJECTIVES: Approximately 20–30% of patients with gastroesophageal reflux disease (GERD) do not experience complete symptom resolution during proton pump inhibitor (PPI) therapy. The aim of this study was to determine the prevalence of esophageal mucosal breaks among patients who have a partial response to PPI therapy.

METHODS: This was an analysis of data from a phase 2b clinical trial carried out to assess the efficacy and safety of a reflux inhibitor, lesogaberan (AZD3355), as an add-on to PPI therapy in this patient population ( reference: NCT01005251). A total of 661 patients with persistent GERD symptoms who had received a minimum of 4 weeks of PPI therapy were included in the study. The prevalence of esophageal mucosal breaks was assessed according to (i) the most recent endoscopy results from within the previous 24 months, if available (“historical” endoscopies), and (ii) the results of endoscopies performed at study baseline (“baseline” endoscopies). Baseline endoscopies were not carried out in patients who had a historical endoscopy showing an absence of esophageal mucosal breaks.

RESULTS: Historical endoscopy results were available for 244 patients, of whom 48 (19.7%) had esophageal mucosal breaks. Baseline endoscopies were carried out in 465 patients, of whom 146 (31.4%) had esophageal mucosal breaks. Sensitivity analyses showed a prevalence of esophageal mucosal breaks of 20–30%. In both the historical and baseline endoscopies, most esophageal mucosal breaks were Los Angeles grades A or B.

CONCLUSIONS: In patients with GERD symptoms partially responsive to PPI therapy, mild-to-moderate severity esophageal mucosal breaks are common (prevalence 20–30%), and may contribute to symptom etiology.

1 Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA

2 AstraZeneca R&D, Mölndal, Sweden

3 AstraZeneca R&D, Wilmington, Delaware, USA

Correspondence: Nicholas J. Shaheen, Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA. E-mail:

Received 22 June 2012; accepted 3 December 2012

published online 15 January 2013

© The American College of Gastroenterology 2013. All Rights Reserved.
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