Repeating endoscopy or persisting proton pump inhibitor treatment for older patients with mild reflux esophagitis: A hospital-based study

Background: Persistent symptoms of reflux esophagitis (RE) trigger two choices in management: repeating endoscopy and prolonging proton pump inhibitor (PPI) treatment. The main purpose of this study was to evaluate the clinical outcomes between the two approaches in older patients with mild RE. Methods: Data of a retrospective cohort from 6702 endoscopies done in a tertiary medical center in Taiwan were obtained. In total, 1059 patients (mean age = 52.9 ± 16.7 years, 56.0% men) with first-ever endoscopic diagnosis of mild RE (Los Angeles Grade A/B) were enrolled. The medical records of patients' progress over the next 12 months were then reviewed. Results: Overall, 199 patients received either repeated endoscopies or prolonged PPI treatment because of the presence of symptoms. Among them, 140 (13.2%) patients (mean age = 57.9 ± 15.6 years, 62.9% men) had repeated endoscopies and 59 (5.6%) patients (mean age = 64.7 ± 15.6, 71.2% men) received prolonged PPI treatment, indicating that physicians tended to favor repeated endoscopies rather than persist with PPI use in Taiwan. Multivariate logistic regression showed that age >60 years [odds ratio (OR) = 2.89, 95% confidence interval (CI) = 1.65-5.05, p < 0.001]; presence of Barrett's esophagus (OR = 4.07, 95% CI = 1.53-10.79, p = 0.005); and presence of hiatal hernia (OR = 2.55, 95% CI = 1.25-5.21, p = 0.01) were all independent predictive factors for persistent PPI use. Conclusion: Among older patients with mild RE, physicians tended to repeat endoscopies than prolong PPI treatment when presence of dyspepsia was noted but no malignancy had been identified. A practice guideline on the treatment of mild RE in older patients would be helpful for physicians to guide their management of such patients.