Dysphagia in patients with erosive esophagitis: prevalence, severity, and response to proton pump inhibitor treatment.
OBJECTIVE
Dysphagia is considered an alarm symptom, raising the question of stricture or malignancy. We sought to determine the prevalence and severity of dysphagia in patients with uncomplicated erosive esophagitis and its response to therapy.


METHODS
A total of 11,945 patients with endoscopically confirmed erosive esophagitis (Los Angeles grades A-D) participated in 5 double-blind, randomized, clinical trials evaluating the efficacy of up to 8 weeks of treatment with either once-daily esomeprazole 40 mg (n = 5068), esomeprazole 20 mg (n = 1243), omeprazole 20 mg (n = 3018), or lansoprazole 30 mg (n = 2616). The severity of dysphagia (4-point scale) was rated at baseline and at week 4. Esophagitis was classified as mild (grade A or B) or severe (grade C or D).


RESULTS
At baseline, 4449 of 11,945 patients (37%) had dysphagia-43% of patients with severe esophagitis, and 35% of patients with mild esophagitis (odds ratio, 1.39; 95% confidence interval, 1.27-1.51, P < 0.001). Dysphagia resolved in 83% of patients after 4 weeks of proton pump inhibitor (PPI) treatment. Resolution of dysphagia was associated with a mean healing rate of 90% across all treatments. Seventeen percent of patients reported persistent dysphagia, and in these patients the healing rates were decreased significantly (mean 72%; P < 0.0001).


CONCLUSIONS
Dysphagia is common in patients with erosive esophagitis but is not a reliable clinical predictor of severe erosive esophagitis. Dysphagia resolved with PPI therapy in most cases, but persistent dysphagia may indicate failed healing.
University of Wisconsin Medical School, Aurora Sinai Medical Center, Milwaukee 53201-0342, USA. nvakil@wisc.edu
Nimish B
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Vakil
Barry
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Traxler
Douglas
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Levine
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D004942:Esophagitis, Peptic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017494:Proton Pumps / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
D000897:Anti-Ulcer Agents; D017494:Proton Pumps