Risk factors for symptom relapse in patients with Los Angeles Grade A/B erosive esophagitis

Recurrence of reflux symptoms following discontinuing proton pump inhibitor therapy is a common problem in the treatment of gastroesophageal reflux disease. We aim (1) to examine the cumulative 12-week incidence of symptom relapse following 8-week proton pump inhibitor therapy in patients with Los Angeles grade A/B erosive esophagitis and (2) to search the risk factors predicting symptom relapse in the treatment of erosive esophagitis. From June 2010 to May 2019, patients with Los Angeles Grade A/B erosive esophagitis receiving esomeprazole therapy (40 mg qd) for 8 weeks followed by complete symptom resolution were included in this study. Subjects received on-demand esomeprazole treatment for 12 weeks and underwent prospective follow-up for reflux symptoms. 12-week cumulative incidence of symptom relapse was assessed, and predictive risk factors for symptom relapse were determined by multivariate analysis. 219 patients with Los Angeles Grade A/B erosive esophagitis who achieved complete symptom resolution following 8-week esomeprazole therapy were enrolled. During the 12-week follow-up period, 110 patients (50.2%) developed symptom relapse. Univariate analysis showed that symptom relapse was significantly associated with advanced age, smoking, and the presence of heartburn (p = .003, .015, and .042, respectively). Multivariate analysis with stepwise logistic regression showed that only advanced age (95% confidence interval [CI]: 1.45-5.15) and smoking (95% CI: 1.30-6.58) were independent factors predicting symptom relapse with odds ratios of 2.74 and 2.92, respectively. The 12-week cumulative incidence of symptom relapse following initial proton pump inhibitor treatment in patients with Los Angeles grade A/B erosive esophagitis is 50.2%. Advanced age and smoking are independent risk factors predicting symptom relapse following treatment in patients with mild erosive esophagitis.