Profile of patients presenting with heartburn and treatment of erosive esophagitis with Esomeprazole - an experience

Abstract

It`s a descriptive analytical study done at Lahore Gut and Liver Centre during March 2005 to February 2006. Material & method: 260 patients who presented with heartbum were included in the study. Their symptoms are recorded and graded a/c to severity. Upper GI Endoscopy done to grade the mucosal injury a/c to LA Classification. First forty patients who were having Erosive Esophagitis were started on Esomeprazole 40mg once daily. Patient reviewed after every 2 weeks for symptom improvement and adverse events. After 8 weeks UGIT Endoscopy repeated to see mucosal improvement in those patients in which mucosal break was recorded at the start of therapy (a/c to LA Classification). Dose increment to 40mg twice a day made, if no symptomatic improvement in 2 weeks. Results: 260 patients in the range of 16 to 75 years, with mean age 37 years, with male to female 1:1.4, mean BMI 29%. 40% were smokers and 10% taking regular Alcohol (25 units/week), 12% got DM. 3% got Chronic Liver Disease due to HCV infection. Regurgitation 75%, Nausea/Vomiting 30% Chest Pain. 20% dysphagic 10%, water brash 60%, Epigastric pain 30%, Early Satiety 35%, Bloating 20%. 95 patients (36.53%) had Erosive Esophagitis; 155 patients (59.6%) no evidence of mucosal injury; 10 patients (3.84%) got Barret`s Eshophegitis. First forty patients who showed Erosive Esophagitis has age range of 16-60 years. 38 patients completed the therapy, 2 patients lost to follow up. Main age was 35 years with male to female ratio of 1.2:1.45% patients were smokers, average BMI of 30. An improvement trend in symptoms by at least 2 levels a/c scale was seen in 20% in 2 weeks, 50% by 4 weeks and 95% by 8 weeks. At the end of study (8 weeks) improvement in mucosal change is 100%. The adverse events noted are bloating 45% and loose stools and headache 20% each. Conclusion: Various overlap symptoms are common in GERD. Endoscopic negative GERD is common, Esomeprazole is effective in GERD.