Gastro-oesophageal reflux disease: symptoms, erosions, and Barrett’s—what is the interplay?

The presence of Barrett’s oesophagus may exert a negative impact on healing of erosive oesophagitis in gastro-oesophageal reflux disease The outcomes of patients with erosive oesophagitis, treated with acid suppression therapy (proton pump inhibitors), has been dictated by the baseline severity of erosive oesophagitis, presence of hiatus hernia, duration of therapy and, in some studies, by the Helicobacter pylori status of the patients.1,2 It has been shown that higher grades of erosive oesophagitis (Los Angeles grades C and D) have significantly lower healing rates as opposed to those with lower grades of erosive oesophagitis (grades A and B). Moreover, the majority of the oesophagitis trials have evaluated healing at four and eight weeks, showing a higher proportion of patients with all grades of erosive oesophagitis healed at week 8 compared with week 4.3,4 Similar data on healing at >8 weeks are not consistently available in the literature. Not only do patients with severe grades of erosive oesophagitis have a higher degree of oesophageal acid exposure compared with those with either no oesophagitis or low grades of oesophagitis, but they also have low amplitude of oesophageal contractions and the presence of large hiatus hernias.5 Therefore, it is not surprising that the poor pathophysiology associated with severe erosive oesophagitis leads to poor healing rates. Although a few studies have correlated H pylori status with oesophagitis healing, with H pylori positivity associated with improved healing rates, this has not been consistently documented.6 This may be a phenomenon …