From the Guidelines
The treatment for grade C reflux esophagitis primarily involves proton pump inhibitors (PPIs) at standard or double doses for 8-12 weeks, as this approach has been shown to be effective in healing erosive esophagitis and preventing recurrence 1.
Key Considerations
- Medications like omeprazole (20-40 mg daily), esomeprazole (40 mg daily), pantoprazole (40 mg daily), or lansoprazole (30 mg daily) are effective options for the initial healing phase.
- After the initial healing phase, maintenance therapy with a standard PPI dose is typically continued long-term to prevent recurrence, as grade C esophagitis represents severe disease with extensive mucosal breaks.
- Lifestyle modifications should accompany medication, including:
- Weight loss if overweight
- Elevating the head of the bed 6-8 inches
- Avoiding meals 2-3 hours before bedtime
- Eliminating trigger foods (caffeine, alcohol, fatty foods, chocolate)
- Smoking cessation is strongly recommended.
Further Evaluation and Alternative Therapies
- If symptoms persist despite optimal PPI therapy for 12 weeks, further evaluation with endoscopy or pH monitoring may be necessary 1.
- In refractory cases or for patients unable to tolerate long-term medication, anti-reflux surgery (fundoplication) may be considered, although the decision should be made with caution, weighing the benefits against the potential risks and side effects of surgery 1.
Rationale
PPIs work by blocking acid production in the stomach, allowing the esophageal mucosa to heal and preventing further damage from acid exposure. The choice of treatment should prioritize the reduction of morbidity, mortality, and improvement of quality of life, with a focus on the most recent and highest quality evidence available.
From the FDA Drug Label
In the two trials described and in several smaller studies involving patients with moderate to severe erosive esophagitis, lansoprazole produced healing rates similar to those shown above. Regardless of initial grade of erosive esophagitis, lansoprazole 15 mg and 30 mg were similar in maintaining remission.
The treatment for grade C reflux esophagitis is lansoprazole.
- The recommended dosage is 15 mg or 30 mg daily.
- Lansoprazole was more effective than ranitidine in healing reflux esophagitis and maintaining remission 2.
From the Research
Treatment for Grade C Reflux Esophagitis
The treatment for grade C reflux esophagitis typically involves the use of proton pump inhibitors (PPIs) as the first-line therapy.
- PPIs are the most effective agents in the treatment of gastroesophageal reflux disease (GERD) and have been shown to be effective in healing esophagitis and relieving symptoms 3, 4, 5.
- The standard dose of PPIs is recommended as the initial treatment for erosive esophagitis, including grade C reflux esophagitis, and should be taken for at least 8 weeks 3, 5.
- Twice daily PPI therapy may be more beneficial than once daily therapy for patients with severe esophagitis, such as grade C reflux esophagitis 5.
- Long-term continuous PPI or on-demand therapy may be required for the majority of GERD patients after the initial treatment 3, 5.
- Histamine H2 receptor antagonists (H2RAs) may be used as a supplementary drug for patients with nocturnal refluxes, but PPIs are generally more effective 4.
- Prokinetic agents and mucosal protective drugs have limited roles in the treatment of reflux esophagitis 3, 6.
- Anti-reflux surgery can be considered in well-selected patients who do not respond to medical therapy or have complications of GERD 3, 7.