Department of Gastroenterology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan.
Department of Medical Checkup Center, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan.
Digestion. 2023;104(4):283-290. doi: 10.1159/000528690. Epub 2023 Jan 30.
This study aimed to investigate the clinical course of patients with healed mild erosive esophagitis and clarify the predictive factors for continuous treatment.
Fifty-one patients with mild erosive esophagitis who confirmed mucosal healing by endoscopy after initial treatment with vonoprazan (VPZ) were enrolled. The patients continued subsequent treatment of their choice: maintenance therapy with VPZ 10 mg (n = 15), on-demand therapy with VPZ 20 mg (n = 19), or no medication (n = 17). Each patient was prospectively followed up for over 2 years, and the treatment was switched to other options appropriately according to their symptoms.
During the mean follow-up period of 3.1 years (range: 2.0-3.9 years), 2 patients who chose maintenance therapy switched to on-demand therapy. One patient who chose on-demand therapy switched to maintenance therapy, while 3 patients switched to no medication. Recurrence of symptoms occurred in 9 patients who chose no medication. They were administered maintenance therapy and five of them were subsequently switched to on-demand therapy. Ultimately, the proportion of patients receiving each treatment was 35.3% (18/51) for maintenance therapy, 43.1% (22/51) for on-demand therapy, and 21.6% (11/51) for no medication. A predictive factor for the need for continuous treatment was the presence of esophageal hiatal hernia (odds ratio: 6.03, 95% confidence interval: 1.43-25.3, p = 0.014).
Among patients with healed mild erosive esophagitis, 78.4% required continuous treatment with VPZ, while 21.6% remained symptom free with no medication. On-demand therapy was the most common treatment, and continuous treatment may be recommended for patients with esophageal hiatal hernia.
本研究旨在探讨愈合性轻度糜烂性食管炎患者的临床病程，并阐明持续治疗的预测因素。
本研究纳入了 51 例经内镜证实初始使用沃诺拉赞（VPZ）治疗后黏膜愈合的轻度糜烂性食管炎患者。这些患者继续选择以下治疗方案：VPZ 10mg 维持治疗（n=15）、VPZ 20mg 按需治疗（n=19）或不进行药物治疗（n=17）。每位患者均进行了超过 2 年的前瞻性随访，并根据症状适当将治疗方案转换为其他选择。
在平均 3.1 年（范围：2.0-3.9 年）的随访期间，2 例选择维持治疗的患者转换为按需治疗。1 例选择按需治疗的患者转换为维持治疗，而 3 例患者转换为不进行药物治疗。选择不进行药物治疗的 9 例患者出现症状复发，给予维持治疗，其中 5 例随后转换为按需治疗。最终，接受每种治疗方案的患者比例分别为：维持治疗 35.3%（18/51）、按需治疗 43.1%（22/51）和不进行药物治疗 21.6%（11/51）。持续治疗的预测因素是食管裂孔疝的存在（比值比：6.03，95%置信区间：1.43-25.3，p=0.014）。
在愈合性轻度糜烂性食管炎患者中，78.4%需要持续使用 VPZ 治疗，而 21.6%无需药物治疗即可无症状。按需治疗是最常见的治疗方法，对于食管裂孔疝患者可能需要推荐持续治疗。
