Severe gastro-oesophageal reflux disease.
A 60-year-old woman with an unremarkable medical history complained of a retrosternal burning sensation, heartburn and regurgitation, with twice-monthly symptoms evolving over 10 years. Upper digestive endoscopy (UDE) showed the lower oesophageal lumen to be reduced in diameter, with bleeding, longitudinal ulcers covering the oesophageal circumference, compatible with a diagnosis of Los Angeles class D severe erosive gastro-oesophageal reflux disease. Oral pantoprazole 40 mg every 12 hours was prescribed. Symptoms of pyrosis and intermittent dysphagia resolved after 8 weeks' treatment and repeat UDE showed the terminal portion of the oesophageal lumen to be of normal calibre with the presence of a small, hardened ulcer. The patient continued to receive maintenance therapy with once-daily pantoprazole 40 mg. Effective 24-hour control of intra-oesophageal pH at levels>4 is necessary for the treatment of oesophageal acid gastric reflux; proton pump inhibitors are currently the gold standard enabling long-term symptom control and reversal of endoscopic lesions.
Gonçalves
Ana Rita
AR
Centro Hospitalar Lisboa Norte, Hospital Santa Maria, Lisboa, Portugal.
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004935:Esophageal Diseases / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D000077402:Pantoprazole; D014456:Ulcer / Q000150:complications / Q000188:drug therapy* / Q000473:pathology
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D000077402:Pantoprazole