title: The impact of body mass index on the application of on-demand therapy for Los Angeles grades A and B reflux esophagitis.
abstract: OBJECTIVE
  Patients with Los Angeles grade A or B reflux esophagitis (RE-AB) can potentially be switched from active-phase therapy to on-demand esomeprazole as maintenance therapy. Body mass index (BMI) correlates significantly with reflux symptoms. We investigated whether BMI affects the efficacy of esomeprazole in active-phase or subsequent on-demand therapy.
  
  
  METHODS
  Three hundred fifty patients with RE-AB were prospectively enrolled to receive an 8-wk course of esomeprazole (40 mg/day) as active-phase therapy. Based on the daily severity of acid regurgitation and heartburn, the cumulative proportions of patients with sustained symptomatic response (SSR), defined as free from symptoms for the last 7 days, were compared among different BMI groups (control: BMI <25 kg/m2, overweight: BMI 25-30 kg/m2, obese: BMI >30 kg/m2). In patients who had achieved SSR by week 8, on-demand therapy for 2 months was started. The number of 40-mg esomeprazole tablets used per 4-wk period was recorded.
  
  
  RESULTS
  SSR rates were lower in both the overweight and obese groups than in the control group (P < 0.001). During on-demand therapy, the mean number of tablets used per 4-wk period was lower in the control group than in either the overweight or the obese group (13.2 vs 15.3 or 16.2, P < 0.05). The failure rate of on-demand therapy increased with increasing BMI-2.4%, 5.3%, and 14.2%, respectively, for the control, overweight, and obese groups (P= 0.002).
  
  
  CONCLUSIONS
  For RE-AB, a higher BMI decreases the rate of SSR after 8-wk of esomeprazole therapy, and increases the need for medication and the failure rate of on-demand therapy.
authors.affiliation: Department of Internal Medicine, and Graduate Institute of Clinical Medicine, National Cheng Kung University Medical Center, Tainan, Taiwan.
authors.forename: Bor-Shyang
authors.initials: BS
authors.lastname: Sheu
authors.forename: Hsiu-Chi
authors.initials: HC
authors.lastname: Cheng
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Chang
authors.forename: Wei-Ying
authors.initials: WY
authors.lastname: Chen
authors.forename: Ai-Wen
authors.initials: AW
authors.lastname: Kao
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D015992:Body Mass Index; D004305:Dose-Response Relationship, Drug; D064098:Esomeprazole / Q000627:therapeutic use*; D004942:Esophagitis, Peptic / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000897:Anti-Ulcer Agents; D064098:Esomeprazole