PMID- 12115018
OWN - NLM
STAT- MEDLINE
DCOM- 20020924
LR  - 20191106
IS  - 1075-2765 (Print)
IS  - 1075-2765 (Linking)
VI  - 9
IP  - 4
DP  - 2002 Jul-Aug
TI  - Long-term clinical outcome of elderly patients with reflux esophagitis: a 
      six-month to three-year follow-up study.
PG  - 295-300
AB  - Although the prevalence of reflux esophagitis is known to increase with age, data 
      on the long-term outcome of esophagitis in elderly patients are scarce. We sought 
      to evaluate the clinical outcome of elderly patients with esophagitis 6 months to 
      3 years after diagnosis and to identify specific prognostic indicators of a poor 
      outcome. This was a long-term (6 months to 3 years) follow-up study. Patients 
      older than 65 years of age diagnosed as having reflux esophagitis healed after 
      acute treatment (2 to 4 months) were included in the study. Clinical examinations 
      and upper gastrointestinal endoscopy were performed every 6 months for the first 
      year and annually thereafter. After healing, no therapy was prescribed; in the 
      event of symptom recurrence, a maintenance therapy consisting either of H2 
      blockers or proton pump inhibitors (PPI) was prescribed. At baseline and during 
      follow-up, the following clinical parameters were recorded: gender, age, the 
      presence of symptoms (heartburn, acid regurgitation, epigastric/chest pain), type 
      and dose of the maintenance therapy, nonsteroidal antiinflammatory drug use; 
      gastric Helicobacter pylori infection, diagnosis of hiatal hernia, and/or 
      Barrett's esophagus. The chi-square test, the Kaplan-Meier test, and Cox's 
      proportional hazards regression analysis were used for statistical analyses. 
      Included in the final analysis were 138 patients (M/F, 81/57; mean age, 79.7 
      years; range, 66-97). The numbers of patients in need of maintenance therapy were 
      47 of 69 (68.1%) after 6 months, 29 of 58 (50%) after 12 months, 17 of 39 (43.6%) 
      after 24 months, and 12 of 26 (46.1%) after 36 months of follow-up. A 
      significantly higher esophagitis relapse rate was found in patients not treated 
      compared with subjects who were in maintenance therapy: 59% versus 8.5% (P 
      <.0001) at 6 months, 65.5% versus 20.7% at 12 months (P <.002), 63.6% versus 
      11.7% at 24 months (P =.003), and 57.1% versus 8.3% at 36 months (P =.02). No 
      significant difference in relapse rate was found in patients treated with H2 
      blockers versus PPIs (21.7% versus 10%). The Cox model demonstrated that no 
      maintenance treatment (P =.00001), the presence of typical symptoms (P =.00001), 
      the presence of hiatal hernia (P =.03), and a high severity grade of esophagitis 
      at baseline (P =.009) were risk factors for relapse of esophagitis. In elderly 
      subjects, esophagitis relapse occurs in a high percentage of cases, particularly 
      in patients not treated with antisecretory drugs. The presence of typical 
      symptoms, hiatal hernia, and a severe grade of esophagitis are risk factors for 
      relapse. The most effective measure for minimizing the occurrence of relapse is a 
      maintenance therapy with antisecretory drugs.
FAU - Pilotto, Alberto
AU  - Pilotto A
AD  - Digestive Pathophysiology Center for the Elderly, Dept. of Geriatrics, Vicenza, 
      Italy. alberto.pilotto@libero.it
FAU - Franceschi, Marilisa
AU  - Franceschi M
FAU - Leandro, Gioacchino
AU  - Leandro G
FAU - Novello, Romeo
AU  - Novello R
FAU - Di Mario, Francesco
AU  - Di Mario F
FAU - Valerio, Gianni
AU  - Valerio G
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Ther
JT  - American journal of therapeutics
JID - 9441347
RN  - 0 (2-Pyridinylmethylsulfinylbenzimidazoles)
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Benzimidazoles)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0 (Sulfoxides)
RN  - 0K5C5T2QPG (Lansoprazole)
RN  - D8TST4O562 (Pantoprazole)
RN  - KG60484QX9 (Omeprazole)
SB  - IM
MH  - 2-Pyridinylmethylsulfinylbenzimidazoles
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Ulcer Agents/*therapeutic use
MH  - Benzimidazoles/therapeutic use
MH  - Esophagitis, Peptic/*drug therapy
MH  - Female
MH  - Follow-Up Studies
MH  - Gastroscopy
MH  - Humans
MH  - Lansoprazole
MH  - Male
MH  - Omeprazole/*analogs & derivatives/therapeutic use
MH  - Pantoprazole
MH  - Prognosis
MH  - Proton Pump Inhibitors
MH  - Recurrence
MH  - Sulfoxides/therapeutic use
MH  - Time Factors
EDAT- 2002/07/13 10:00
MHDA- 2002/09/25 06:00
CRDT- 2002/07/13 10:00
PHST- 2002/07/13 10:00 [pubmed]
PHST- 2002/09/25 06:00 [medline]
PHST- 2002/07/13 10:00 [entrez]
AID - 10.1097/00045391-200207000-00006 [doi]
PST - ppublish
SO  - Am J Ther. 2002 Jul-Aug;9(4):295-300. doi: 10.1097/00045391-200207000-00006.