title: A model of healing of Los Angeles grades C and D reflux oesophagitis: is there an optimal time of acid suppression for maximal healing?
abstract: BACKGROUND
  In patients with Los Angeles (LA) grade C or D oesophagitis, a positive relationship has been established between the duration of intragastric acid suppression and healing.
  
  
  OBJECTIVE
  To determine whether there is an apparent optimal time of intragastric acid suppression for maximal healing of reflux oesophagitis.
  
  
  METHODS
  Post hoc analysis of data from a proof-of-concept, double-blind, randomized study of 134 adult patients treated with esomeprazole (10 or 40 mg od for 4 weeks) for LA grade C or D oesophagitis. A curve was fitted to pooled 24-h intragastric pH (day 5) and endoscopically assessed healing (4 weeks) data using piecewise quadratic logistic regression.
  
  
  RESULTS
  Maximal reflux oesophagitis healing rates were achieved when intragastric pH >4 was achieved for approximately 50-70% (12-17 h) of the 24-h period. Acid suppression above this threshold did not yield further increases in healing rates.
  
  
  CONCLUSIONS
  After 4 weeks' acid-suppressive therapy for LA grade C or D oesophagitis, successful healing appears to reach a threshold above which improvements are unlikely to be achieved despite an increase in number of hours with intragastric pH >4.
authors.affiliation: Albert Einstein Medical Center, Philadelphia, PA 19141, USA. katzp@einstein.edu
authors.forename: P O
authors.initials: PO
authors.lastname: Katz
authors.forename: D A
authors.initials: DA
authors.lastname: Johnson
authors.forename: D
authors.initials: D
authors.lastname: Levine
authors.forename: K
authors.initials: K
authors.lastname: Röhss
authors.forename: O
authors.initials: O
authors.lastname: Junghard
authors.forename: M
authors.initials: M
authors.lastname: Astrand
authors.forename: P
authors.initials: P
authors.lastname: Nagy
mesh_terms: D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D064098:Esomeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D014945:Wound Healing; D055815:Young Adult
chemical_list: D064098:Esomeprazole